HomeMy WebLinkAbout6714 ANTIGUA DR - APPLICATIONS - 4/5/2012City Of Planning, Development St Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-416-2740 Fax 224-61M
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OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). KAir 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 ❑ 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 # 9 I a () 1- q —1 LP
For office use only
Date 41 ,5- /al,
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Address
City/ fate Zip
Co
Phone
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-45
Applicant Name
Address
City/State Zip
Phone
ntractor
Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report? 19Here
❑ Report
sales tax number & required byall ronbaciois
Are you paying with your trust account? ❑ Yes
XNO
Is this a residential or commercial project? K Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ,6Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartrnent) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ANo If yes, you may need to contact Historic Pfeseruabon
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.
Description of
*If lawn sprinlder/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Qy of Ft Collins license 0
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:
Print Name: QG Signatu Date �oC
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