HomeMy WebLinkAbout4625 VENTURI LN - APPLICATIONS - 3/18/2015 (2)City of Planning, Development & rransportaltion
�ort 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),13 Air Conditioning
la Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit 11 Lawn Sprinkler ❑ Mobile Home replacement ❑ Rooting ❑ Sewer Line O Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable
r�innform'lation on the application.
Application # E 1E0I � ` 0
ICo/ office use only
Incomplete applications will not be accepted.
Date
Job Site Address (�u;,rd1
Value of construction (labor, materials, profit)
Property Owner Name
Address
City/S to
Zip Phone
Applicant Name
Address
City/State
Zip Phone
Contractor
Address
A � e rr
City/State
. .
Zi P Phone
- -. _
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? iYHere ❑ Report
sales rarnumt�risrcvurrederaomno-acros Are you paying with your trust account? 0 Yes J;VNo
Is this a residential or commercial project? ,Residential ❑ Commercial
If residential, Is it: Ingle Family Detached ❑ Condo/townhome (single family attached) O Duplex
❑ Multifamily (apartment) IF Garage
If Commercial, is it. Cl Bank ❑ 8ar ❑ Church 0 HotWiMotel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes JpNo If yes, you may need to contact Historic PreServatlon
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfloy(preventer, must list licensed plumber, If first-time A/C, must list kensed electrician.
Subeo11t1 actors: List the company name ar aty of Ft Collins license # D
Fleetiman _ Plumber. Mechanical Roofer PZW— 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 taws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant:
print Name.lJoIllie
-s'
Date