HomeMy WebLinkAbout907 BUTTE PASS DR - APPLICATIONS - 7/24/2014City}}Of For Planning, Development & Transportation
Flirt Collins N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740740 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 ��oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation. El Water Heater ❑ Water Line [IWood/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 # '26I+0A-33dk1 Date -7 Lzsf 41c%
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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2-z 0 (D
Property Owner Name
Address
City/Stat Zip
Phone
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Pass r GU I
270 97�3-Z7
Applicant Name
Address
city/State Zip
Phone
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Contractor
Address
City/State Zip
Phone
AsC i nq
Contractor City of Ft. Collins S les Tax #
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ;algo
Is this a residential or co ercial project? A Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) El 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 ❑ 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.
Description of work
Klti' a
*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 #
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: i 1 r' E!(!!tSignature
Date