HomeMy WebLinkAbout508 JANSEN DR - APPLICATIONS - 1/4/2012of
F6rt 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 A00fing ❑ 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 #
For office use only
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
b 8 anseo ve .30oD
Property Owner Name Address
City/State
Zip
Phone
A ee- Yow n 5C? J mse
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Applicant Name Address
City/State
Zip
Phone
Contractor Lic # & I-Ib Address
City/State
Zap
Phone gJ10
19,0
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Contractor City of Ft Collins Sales Tax # q j 3nU
Are you paying taxes here or by report? ❑ Here
id Report
sale' tax number & rsgrdred by all conbadam
Are you paying with your trust account? W Yes
❑ No
Is this a residential or commercial project? E!Iqtesidential ❑ Commercial
If residential, Is it: JRflngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Histonic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you W// need an asbestos assessment to submit with this app/Icatlon.
of work
S
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If fi -time A/C, must I' /fie/dJetectriaan.
Subcontractors: List the company name or Cty of Ft Collins license # �c /yr.�r it
Electrician Plumber
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.
Applicant: Joy F
Print Name: Signature
Date _ / y// Z
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