HomeMy WebLinkAbout4306 NEW BEDFORD DR - APPLICATIONS - 8/14/2014Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
F6 t6 CoWns 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 ervice change) El Gas Lighter ❑ Gas Log
❑ Heating Unit El Lawn Sprinkler ❑ Mobile Home replacement 1, 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 # I-PoL'ci Date I
For office use only
]ob Site Address (required)
Value of Construction (labor, materials, profit)
bl3eu " '"
T1
3
Property Owner Name Address
City/Stat Zip Phone
DAV e a e pia o(a me"R' co 0 S'zS '7 10-zr'-(-3
Applicant Na a Address
�`'
City/State Zip Phone
�f.�
d G s. -�-a� - oa�At
��� �o -2 1-7
Contractor Address
City/State Zp Phone
{
!i✓✓1 .fivr� �� .2r
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number is required by all contractors.
Are you paying with your trust account?.,�- es ❑ No
Is this a residential or commercial project? �M
If residential, is it: .2 Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No ifyes, 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
*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:5';1 .-C Signature a°i 7/ Date
u v
?77