HomeMy WebLinkAbout6126 CRANE DR - APPLICATIONS - 7/17/2012City of Planning, Development & Transportation
�oa t Collins 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 I$ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application #
PP For offs e use only
Job Site Address (required)
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Incomplete applications will not be accepted.
Date
Value of Construction (labor, materials, profit)
$ 94: ,
Property Owner Name Address
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City/State Zip
Phone
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Applicant Name Address
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City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone V !-
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131 /V. Y11a t.K _'2t //i'✓IS'
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? ❑Here 13(Report
Sales tax number Is required by allcontractom
ZZ S5 -7
Are you paying with your trust account? 51 Yes ❑ No
Is this a residential or commercial project? ® Residential' ❑ Commercial
If residential, Is it: CR Single Family Detached ' ❑ Condo/townhome (single family attached) ❑ Duplex
4 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Hisiorlc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpdor to 1975, you will need an asbestos assessment to submit with bbls application.
Description of work r e ,, 1 e, r
is lawn bpnmuepoacxriow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of H Collins license
Electrician Plumber Mechanical Roofer Other
i nereoy 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: y\ Signatu / -
ate Zee Z