HomeMy WebLinkAbout874 CAMPFIRE DR - APPLICATIONS - 5/28/2014FROM :NCA FAX NO. :9702299983 May. 28 2014 08:56AM 133i3
City OF Planning, Development&Transportation
Fort Collins For N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVEWTHE-COUNTER PERM17S ONLY
This application is to be used to apply for the following permits only (check all that apply). IVAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -Voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certifled, provide make, model and
manufacturer).
Complete all applicable Information on the application, Incomplete applications will not be accepted.
Application # ��OZ-Date
for office use only
Job Site Address (required)
Value of Construction (later, materials, profit)
Property Owner Name Address
City/State 'Zip
Phone
tA�Y_ �.
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Applicant Name %Address
I V City/State Zip
Phone
Contractor Address
City/State F -C tllikczip
Phone Of7)a
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Contractor City of Ft, Collins Sales Tax #
Are you paying taxes here or by report? hilliere ❑ Report
Sa�estaxnunaerlsrequhWbya#ca7trettorr.
Are you paying with your trust account?)KYes ❑No
Is this a residential or commercial project? /Residential 17 Commercial
If residential, is It: firSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, Is It:. ❑ Bank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
El Restaurant ❑ Other (e lain)
Is this building s0 years of age or more? CI Yes No If,, you may need to eontatY Histnric iLa..tion
If this is for a demolition permit, what year was the building constructed?
If prior to 1975,• you and/l need an asbestos assessment to submit with this appllmdon.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber, If first-time A/c, must list licensed electrician.
Subcontractorss I& the company name or City of ft Collins #rense ,s
Electrician Area Plumber Medwnical 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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