HomeMy WebLinkAbout1809 ROSEMARY CT - APPLICATIONS - 12/14/2015F®rt of
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Z'Sater Heater ❑ Water Line ElWood/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 # 1E) Sb ggquo Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
i - /State Zip
Phone
Contractor I Address'' 1 f
City/State i I Zi _
Phone
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Contractor
Contractor City of Ft. Collins S les�ax #
Are you paying taxes here or by report? -E 'Here ❑ Report
Sales tax number is required by all contractmv
Are you paying with your trust account?)2,Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ols�ingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed 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, crust list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company e
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n pr Ci of Ft Collins license #
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Electrician Plumber Jr X� 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 Nam � 'Si I. � r �_ Signatu�b : �� ' : l ! lsn�/ Date >/��/