HomeMy WebLinkAbout908 TOD DR - APPLICATIONS - 8/30/2018Cityof Planning, Development, & Transportation Services
6rt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 # �AG 714�6 Date
For office use only X ORE + I1 U14F $A1Z
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Job Site Address (required) "�Ewil17$ Value onstruction (labor, materials, profit)
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Property Owner Name Address City/State Zip Pho
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Pho e
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ e ort
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: Jl 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 b( No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
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 license#
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Electrician T54w Plumber Mechanical Roofer D 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:
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Name: c , li FF'f(�{ Signat
Print N' _ Date'. =+' I
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Revision date 2162017