HomeMy WebLinkAbout604 SKYLINE DR - APPLICATIONS - 10/26/2015City of
F&t C dhns
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
ElDemolition (interior non-structural) ElElectrical Alteration (not s rvice 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. "v
Application # f> fj� "Re
For office use only
Date
Job Site Address (required)
Value of onstruction (labor, materials, profit)
Property Owner Name Address
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City/State Zip Phone 971i
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Applicant N'am�e" Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
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9�^�-�S-57-7ipa1
Contractor City of Ft. Collins Sales Tax #
salostax number isrequiredbyall contractors.
Are you paying with your trust account? ❑ Yes XNo
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: Asingle 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? ❑ Yes KNo 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
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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 City of Ft Collins license
Electrician PI
19
Mechanical Roofer 7 G'n—A Other
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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
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