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HomeMy WebLinkAbout4625 VENTURI LN - APPLICATIONS - 3/18/2015FCity of Planningr Development & Transportatiion ort Collins 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-Z740 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-structuraq ❑ Electrical Alteration (not service change) ❑ Gas Lighter El Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement El Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation Q Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Application # &5 1 1 far olrtce use only - Job Site Address (required) Incomplete applications will not be accented. Date`"' Value of Construction (labor, materials, profit) Property Owner Name Address City/State Zip Phone ' Applicant Name Address ` City/State Zip Phone Contractor r Address City/State Zip Phone Contractor City of Ft, Collins Sales Tax # r Are you paying taxes here or by report? WHere '0 Report SAW taw amm&rismqui e%Ybyaiicvntractom Are you paying with your trust account? ❑ Yes $No Is this a residential or commercial project? 41DResidendal o Commercial If residential, is it; AP Single Family Detached 13 Condo/townhome (single family attached] !j Duplex ❑ Multifamily (apartment) 0 Garage If commercial, is it: E3 Bank 13 Bar ❑ Church ❑ Hotel/Motel Q Medical ofnce O office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes p l No if yes, you may need to contact Histonc Preservation If this is for a demolition permit, what year was the building constructed? Ypr/or to 197S, you w/I/ need an asbestos assessment to submit with this appllcatlon, of work *If lawn sprinkler/backPow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician. Subcontractors: Usr the company name or City of Ft Collins license ? � EIKWCian _ Plumber Meet lcal Roofer E& 2 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: 9 Print Name. ((/ Date /��/