HomeMy WebLinkAbout600 DARTMOUTH CIR - APPLICATIONS - 11/2/2015From:
11/02/2015 06:33 0690 P.002/002
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort
` Collins 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
bleating 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 # V1S0C'0)n1 Date
For office 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
City/State Zip
Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? VrHere
.Report
Sales tax number is rewired by all contractors
Are you paying with your trust account? XYes
El No
Is this a residential or commercial project? VResidentiat ❑ Commercial
If residential, is it: 'ZDSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
�6 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 ❑ No 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 w//I need an asbestos assessment to submit with this application.
Description of
•I 10"iI op11IR1C1rualAuJuw prevemer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Collins license 0
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 taws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant: //�1 I `
Print Name: �NAL—O\Q h. A�XNN Signature Date Lai L