HomeMy WebLinkAbout1133 BENT TREE CT - APPLICATIONS - 6/25/2012City of Planning, Development & Transportations'
281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-61M \
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line O Photo -voltaic
Q Ventilation ❑ Water. Heater ❑ Water Line p 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 # Date (off Z
Far o117cr use only
lob Site Address (required)
Value.of construction (labor, materials, profit)
r
Property Owner Name
Address
City/State Zip
Phone
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Applicant.dame
Address
City/State zip
Phone
RepmoAdass
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Contractor
Address
City/State Zip
Phone
TTL c/C _
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Contractor City of Ft: Collins Sales Ta
#
Are you paying taxes here or by report?Here
❑ Report
saves.tax number iisregwmdbyall cono-acrws.
Are you paying.with your trust account? . Yes
❑ No
Is this a residential or, commercial project? XResidential ❑ Commercial
If residential, is it: Single Family. Detached ❑ Condo/townhome (single family attached) O 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? O Yes XNo 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 2 - — t
a
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Let Me company name or Qy of Ft CaNns I ense k
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 l o `'
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 nNPrint Name:
Signature
Date