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HomeMy WebLinkAbout936 SAILORS REEF - APPLICATIONS - 2/13/2012FROM :NCA FAX NO. :9702299983 Feb. 13 2011 03:29PM P3/3 Fort Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 I •f �,';1 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). CAir Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑Gas Lighter 0 Gas Log .FrHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ 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 #���Date For office use only Job Site Address (required) Value of Construction (labor, materials, profit) 0, OD Prope Owner Name Address City/State Zip Phone V C -a Applicant Name AddressMy/State Zip Phone Contractor Address city/State Zip Phone Cl 0 ✓+ ov' �MAv-An(1 Q12.Sh2(V-A-M AvC F-+Collet C•o F1DS2-4 � Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report Salp_stax numberisrtquiredbyaUmnvaaws Are you paying with your trust account? Yes ❑ No a top 2 Lip Is this a residential or c mmerdal project? Residential ❑ Commercial If residential, is it: Single 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 (explai ) Is this building 50 years of age or more? ❑ Yes No I(yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was th building constructed? Ifpdor to 1975, you will need an asbestos assessment to submit with this application, Description of work *If lawn sprinkler/back low preventer, must list licensed plumber. IF Rrst-tlme A/C, must list licensed electrician. Subcontractors: 'stthe company name orGtyofFtCollins license0 Electrician ✓QLwplumher 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: Print Nam Date a': 27) -) L.