HomeMy WebLinkAbout4130 GRANBY CT - APPLICATIONS - 9/4/2014City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
_F®r{,
¢ Collins Fort Collins, CO 80524
/10�� 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}aO 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.
Application # V
For office use only
Incomplete applications will not be accepted.
Date p y�/
Job Site Address (required)
Value of Construction (labor, materials, profit)
t1/39 "deV or Ba526P
9 sas
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip Phone
Contractor / Address
lc LGC.
City/State Zip
&-
Phone
u6ho PV
R7nf-
Qv`e-
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 19-Report
Sales tax number isrequiredbyall contractors
Are you paying with your trust account?
❑ Yes 9No
Is this a residential or c mmercial project? -0-Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
LJ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex lain)
Is this building SO years of age or more? ElYes No 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/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 #
Mechanical Roofer 111,915
Electrician Plumber
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: �t-1 y �C Signature s/ . Date r