HomeMy WebLinkAbout4512 BLUEFIN CT - APPLICATIONS - 10/2/2014Fort 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 ❑ 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 # L�`—yU- l5 �3 Date IQ-7-1 �}
Foroffice use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
L�
Property Owner Name Address
City/State Zip
Phone
I-Arinlicantlame Address
City/State Zip
Phone
Contractor Address
City/State Zip
2we 2d-1
Phone
Contractor City of Ft. Collins Sales Tax #
Salestaxnuy riissr_equir, y ntrac oP
Are you paying taxes here or by report? %, Here
Are you paying with your trust account? 25.Yes
❑ Rep
❑ No
Is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: Xingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (ex lain)
Is this building 50 years of age or more? ❑ Yes ' "o Ifyes, you may need to contactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpriorto 1975, you willneed an asbestosassessmenttosubmit with thlsapplication.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or Cityof 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.
10'2: �
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