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City Of Planning, Development & Transportation
F6} 281 N. College Ave P.O. Box S80
r`Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-61M
VER-THE-COUNTER PERMITS ONLY
This application is
❑ Demolition (interii
❑ Heating Unit
,-❑,,�1
❑ Ventilation G�,(E
manufacturer).
Complete all applic
Application #
be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
un Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
r Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
information on the application. Incomplete applications will not be accepted.
For olice use only
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Job Site Address (r
wired) �QC
Value of Construction (labor, materials, profit)
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Property Owner Nam
Address
4ity/State Zip Phone
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Applicant Name
Address
City/State Zip Phone
Contractor
Address
City/State Zip Phone
Contractor City of Ft.
Sales tax number is require
Collins Sales Tax #
J by all contractors.
Are you paying taxes here or by report? ire ❑ Report
Are you paying with your trust account? ❑ Yes �-17No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: E I Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Restaurant ❑ Other (explain)
Is this building 50 yea of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolitilon permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
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*If lawn sprinkler/backFl
Subcontractors: List t
Electrician
w preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
e company name or City of R Collins license #
Plumber V Mechanical Roofer Other
I hereby acknowledge
comply with all require
permit is not valid t
I have read this application and state that the above information is complete and correct. I agree to
is contained herein and city ordinances and state laws regulating building construction. I know that a
it has been paid and issued.
Print Name a .r/) Si nature )&&df Date Ito-
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