HomeMy WebLinkAbout664 BREWER DR - APPLICATIONS - 6/9/2015FROM :NCR
FAX NO. :9702299983 Jun. 03 2015 04:03PM P2/2
Planning, Development & Transportation
Flirt of For N. College Ave P.O. Box 580
`bJA Fort Collins, CO 80524
Phone 970.416-2740 Fax 224-6134 & 1
OVER-THE-COUNTER PERMITS ONLY — of .
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
Femolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
entilation 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 acceptedd..
Application #_ 6 jb-04320 Date
For ofcc use only
Job 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
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Contractor City of Ft. Collins Sales Tax 7
Are you paying taxes here or by report? *ere
❑ Report
sales tax number required by a// contractors.
is
Are you paying with your trust account? ACYes
❑ No
Is this a residential or copimercial project? Aesldential ❑ Commercial
If residential, Is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If Commercial, is it: ❑ Bank ❑liar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office Q Retail
❑ Restaurant [I Other (explain)
Is this building 50 years or age or more? ❑ Yes )2riNo If yes, 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
*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 //tense #
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:
Print Name. ffinLslg
Date �_[5__