HomeMy WebLinkAbout925 SHORE PINE CT - APPLICATIONS - 10/13/2014Planning, Development & Transportation
Cityof281 N. College Ave P.O. Box 580
F®e 6 CoWn s Fort Collins, CO 80524
`�— p� 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 # -51410�-, A(A. Date
For office use only
Job Site Address (required)
4s lu � �,
a
Value of Construction (labor, materials, profit) e
,�t ��fF-dl,4 �70
Propek Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
Contractor
-:.100 d,t/
Address
—
City/State Zip
G920
Phone
7
Contractor City of Ft. Co ins Sales Tax #
sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes 4'No
Is this a residential or commercial project? 4esidential ❑ Commercial
If residential, is it: ❑ Single Family Detach d ❑ 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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
1fprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work i -
*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. /ill
Applicant: f�16
Print Name: / � Si nature Date