HomeMy WebLinkAbout4213 SADDLE NOTCH DR - APPLICATIONS - 9/15/2014Ci c Of Planning, Development & ran,
�l 281 N. College Ave P.O. Box' 580
FaI> C t (i t S Fort Collins, CO 80524
L�""��'�^�. Phone 970-416-2740 Fax 224-61
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that appl
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not e..ice change) ❑ Gas Ligl
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing ❑ Sewer Line
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, p
manufacturer).
Complete all applicable information on the application. Incomplete applications will
not
Application # Nqos® ?" q Date �� r
For office use only
❑ Air Conditioning
❑ Gas Log
Photo -voltaic
de make, model and
accepted.
.fob Site Address (required) Value of Construction (labor,
materials, profit)
13 vGo
Property Owner Name Address City/S to Zip
Phone
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Applicant Narpe Address City/State i' Zip �i
Aj
Phone
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Contractor /i Address City/Stater Zip
.
Phone
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) ,,D es ❑ No
Is this a residential or commercial project? �p Residential ❑ Commercial
If residential, is it: .0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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 Ifyes, you mayneed to contactHistorl'c reservation
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 thecompanynameorCity ofFtCollins 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. I'
Applicant: ✓I
Print blame:(" (i r{z i rl i Signature �14y- tGi � � (//�!�, Date