HomeMy WebLinkAbout4307 KINGSBURY DR - APPLICATIONS - 3/2/2015Fort Collins
Planning, Development & Transportation
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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # ���� la� U
For ofce use only
Incomplete applications will not be accepted.
Date TI �O I s
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State
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Applicant Name
Address
City/State
Zip Phone
Contractor
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Address
City/State
Zip Phone 67'70
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Contractor City of Ft. ollins Sales Tax
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Are you paying taxes here or by report? 'H Here ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes 1, No
Is this a residential or commercial project? [E
If residential, is it: %Single Family Detached
Residential ❑ Commercial
❑ Cando/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 1� No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If poor to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work ^ Al( OkAe,'6 / S t 6 Z(� 56-10CV6
2 S�o�y
*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 # I I -
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:_ IQ �� ���� Signature
Date 124-) S