HomeMy WebLinkAbout1133 BENT TREE CT - APPLICATIONS - 7/28/2014FROM :NCA
FAX NO. :9702299983 Jul. 28 2014 10:46AM P10/10
Fort Collins
Planning, Development &Transportation
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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation ❑ Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not b(e' accepted.
Application # ���q-7 l Date a w
For offxe use only
Sob Site Address (requited) Value of Construction (labor, materials, profit)
Property Owner Name _ Address City/State Qe, Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/Stage f- }+ 11MZip Phone Cf"Im
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? .Wlere ❑ Report
Soles tax twmber Is required by all contractors. Are you paying with your trust account? es 0 ,No
Is this a residential or mmercial project? f2Residential ❑ Commercial
If residential, is it, Single Family Detached 0 Condo/townhome (single family attached) O duplex
"`[[[[���� Multifamily (apartment) O Garage
If commercial,. Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai )
If
Is this building BO years of age or more? O Yes No yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was a building constructed?
If prior to 1975, you will need an asbestos assessment to submit w/th this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or City of R CoiNns ik ense #
Plectrldann _ 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 than a
permit is not valid until it has been paid and Issued.
Applicant:
Print Nam,
Date