HomeMy WebLinkAbout625 BLUE MOUNTAIN DR - APPLICATIONS - 7/14/2014Planning; Developm
City of 281 N. College Ave F
FOr` t Collins Fort Collins, CO 80524
/� Phone 970-416-2740
& Transportation
Box 580
224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all tha
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gs
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certi
manufacturer).
Complete all applicable information on the application. Incomplete applications w
Application # 6 YJ d �> 9 5? Date %-1 Y -
For oB9ce use only
apply). ❑ Air Conditioning
Lighter ❑ Gas Log
_ine ❑ Photo=voltaic
3d, provide make, model and
I not be accepted.
Value of Construction
(labor, materials, profit)
Job Site Address (required)
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Property gwner Name
Address
City/State
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Zip Phone
9
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Applicant Name
Address
City/State
Zip Phone
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Contractor
Address
City/State
Zip Phone
/m®
A.C..
Contractor City of Ft. Colli s S Tax #
sales tax number is required by all conbactors #0877
Are you paying with your trust
account? Yes ElNo
Is this a residential or commercial project? yft Residential ❑ Commercial
If residential, is it: J? Single Family Detached ❑ Condo/townhome (single family atta ed) ❑Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ 0 fice ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes goo 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.
A
Description of work
*If lawn sprinlder/backdlow preventer, must list licensed plumber. If first-time A/C, must list
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer
I hereby acknowledge that I have read this application and state that the above Information is
comply with all requirements contained herein and city ordinances and state laws regulating bi
permit is not valid until it has been paid and issued.
Applicant:
Print Name:
S.
Other
:te and correct. I agree to
construction. I know that a
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