HomeMy WebLinkAbout924 VANDERBILT CT - APPLICATIONS - 2/29/2012City of
Fit Collins
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 jKRoofiing ❑ 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 oA`ice use only
Date 2�Zg1tz
Job Site Address (required)
Value o&Construction (labor, materials, profit)
4
Z 7
Property Owner Name Address
City/State Zip Phone
'Guirlin JaM T + 1 I
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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rI- �/T Collins rJ hD52�- r%-to- -Z570Z
Contractor City of Ft: Collins' Sates Tax #
Are you paying taxes here or by report? A Here ❑ Report
Sales tax number is required by all contractors.
S7) 0 30
Are you paying with your trust account? Z Yes ❑ No
Is this a residential or commercial project? W Residential ❑ Commercial
If residential, is it: R 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 (explain)
Is this building 5o years of age or more? ❑ Yes J! No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of work
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license A
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 la s regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: fire, �Q Nk Print Name: � Signature Date