HomeMy WebLinkAbout417 W SKYWAY DR - APPLICATIONS - 4/20/2015Planning, 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 KRoofing ❑ 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 # 91 dm2f' I Date A . ZO .I,CS
For office use only
Sob Site Address (required) ,
Value of Construction. (labor, materials, profit)
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Property Owner Aame
Address
City/State Zip
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Applicant Name
Address
City/State Zip
Phone
Contractor # -t}� 3
Address
City/State Zip
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Contractor City of Ft. Collins Sales Tax # Li 13 q�(o
Are you paying taxes here or by report?
❑ Here X Report
sales tax number is required by allconbactors
Are you paying with your trust account? 4a Yes ❑ No
Is this a residential or commercial project? AResidential ❑ Commercial
If residential, is it: 4 Single Family Detached ❑ 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 IXNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? IV O
Ifpnor to 1975, you wi//need an asbestos assessment to submit with this application.
Description of
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or tarty of Ft Collins license #R-0t 4Xci,L Q-oa-�'', or . A. _ . S
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: 1 ,
Print Name: N f� Signature
Date A
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