HomeMy WebLinkAbout612 MARIGOLD LN - APPLICATIONS - 7/7/2014Planning, Development & Transportation .
City of I 281 N. College Ave P.O. Box 580
Fol1111}, CoLli IS. 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). I/ Air Conditioning
Hremolition (interior non-structural) El Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing D Sewer Line ❑ Photo -voltaic
Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appation on the application. Incomplete applications will not be accepted.
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Application #�jj�l�`'�,i,�Ud``-)gotQ Dat 7"� "�y
For office use only ,_L'00 ex A=ar,6 Z200 l3'
Job Site Address (required)
Value of Construction (labor, materials, profit)
740" S 1012,
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Property Owner Name
Address City/State
Zip Phone
I-JA 1
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Applicant Name
Address City/State
Zip Phone
NA M 1412 (ECG
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Contractor
Address City/State
Zip Phone
Contractor City of Ft. Collins Sales Tax # .
sales taxnu beris quiredbyall contractors Are you paying with your trust account? ❑ Yes ❑ No
0
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: 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 So years of age or more? ❑ Yes t�fNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow 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 #
c-121y PIumber 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: bAV i n tJ A (Lo I Signature Date