HomeMy WebLinkAbout6575 ROOKERY RD - APPLICATIONS - 4/30/2014of
FF6rt Collins
planning, Development & Transportation
281 N. College Ave P.O. Box 580 �a raw
Fort Collins, CO 80524 f (1-1. Gp 7-
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). I4r 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 11 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 # 5/4029 �G Date
For oliice use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property owner Name
Address
City/State Zip
Phone CVID
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Applicant Nam
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
PhonecMO
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Contractor City of . ollins Sales Tax #
Are you paying taxes here or by report?
Are you paying with your trust account?
❑ Here Deport
IyYes ❑ No
sales tar number is required
by allcunbactws
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: Ingle 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 o if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed7
if prior to 1975, you will need an asbestos assessment to submit with Uiis application.
Description of work 15)I
0 1 n 4 rL
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or PY ofH Collins license #
Eieclridan Plumber Mechanical Roofer other
I hereby acknowledge that I have read this application and slate that the above information Is complete and correct. I agree bo
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: 1
Print Name: r aA_ � Signatu G. Date