HomeMy WebLinkAbout41 S TAFT HILL RD - APPLICATIONS - 11/17/2011NOV/18/2011/FP,I 11:57 AM
FAX No,
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P. 001
City of
F„6 rt Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement )4 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # "11 05LPD Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone&j
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Applicant Name Address
City/State Zip Phone
tractor Address
Contractor
City/State Zip Phone
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? X Here ❑ Report
Sales tax number isreovired6yallCamracrars.
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Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Cl-Residential ❑ Commercial
If residential, is it: L91Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ HoteVMotel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
ifprior to 1975, you will need an asbestos assessment to submit P by this applimb7on.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name cr Gty of Ft Collins licanse 0
Electrician Plum
Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
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Applicant:
Print Name:�.f _Y Q U £(U Signature Date I I I