HomeMy WebLinkAbout602 KEENESBURG CT - APPLICATIONS - 6/30/201571�-6�/
Of Planning, Development &Transportation
City. j'a 281 N. College Ave P.O. Box 580
F�r` Colons u/' f(/� Q2 2015 t"� Fort Collins, CO 80524
' j'i' , Phone 970-416-2740 Fax 224-6134
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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. Incomplete applications will not be accepted.
Application # �16C)50K Date / • 30 -/�
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of F . Collins Sales Tax #
Sales tar number is required by allmntractors
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Are you paying taxes here or by report? )9f Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? W
If residential, is it: `Single Family Detached
I Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
❑ Condo/townhome (single family attached)
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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 # .
Electricia4t4trJ 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:
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