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.