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HomeMy WebLinkAbout412 ROBIN CT - APPLICATIONS - 12/29/2015Fort Collins 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 ❑ 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 # Date I — For o ice use only Job Site Address (required) Value of Construction (labor, materials, profit) G/Z,Z - N CZ"_ Lys t �2 Property Owner Name Address City/State Zip Phone /YCI-V G,�+sc)_vs //.? �Qd �;� C7- 7"e. A7c 7.1E f'7o' -7y Applicant Name Address City/State Zip Phone Contractor Lic # Address Zip Phone C� �/% // S , Svc' 'J Atv" ei '� � C L 7 ! L / .5 %City/State/ eV f.[, G. C/ /1 C 7 c JAL SAS 7 CJ/U `C!' 7.SS J. Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? Residential ❑ Commercial If residential, is it: Single 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 ❑ 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 will need an asbestos assessment to submit with this application. Description of work -e �%�M /�« 2!� /�© *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 lr 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 't has been paid and issued. Applicant://� !� `" �� / � i/ Print Name: ! �' c � �'��'� Signature__ "'� � Date �07�^ 52