HomeMy WebLinkAbout4900 LANGDALE CT - APPLICATIONS - 10/31/2014City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6roWns Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
wWER-THE- COUNTER PER fTS ONLY
T -Us 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
I:] 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
r: anufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application �
For office use only
Date A) - 3/—/`�
Job Site Address (required)
Value of Construction (labor, materials, prof . 3c °=
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Property Owner Name Address
City/State
Zip
Phone
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An licant Name
City/State
Zip
Phone
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Contractor Address
City/State
Zip
Phone
0-67L,
Contractor City of Ft. Collins Sales Tax #
Are with trust account?hr?'as
❑No
sa)etax number isrequired byall contractors
you paying your
Is this a residential or coca erdal project? .$fResddential ❑ Commercial
if residential, is it: Single Family Detached ❑ 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? El Yes c Ifyes, you may need to contact Historic Preservation
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 ioM
*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 9 ��r lczo� wtl
Bectrician
Mechanical Roofer g Zo<r 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: Signature Date