HomeMy WebLinkAbout4142 HARBOR WALK DR - APPLICATIONS - 1/22/2016City of
Fort 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 # 131&700962 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
if q -'� I w' \iL 7 2
6
Property Owner Name Address
City/State Zip
Phone
AzjQ'tCG 14) call —_>A"A
Applicant Name Address
City/State Zip
Phone
Contractor Address
r
3oz711
City/State Zip Z-T
flPhone
f !fin_► , F�-�•� `� OF)
C-a h05
90 -Z(go u
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ISHere ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
0 Yes ❑ No
Is this a residential or commercial project? .EMesidential ❑ Commercial
If residential, is it: mangle 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
*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 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 it has been paid and issued.
Applicant: (� a
Print Name: L�- � �' ' -" �� +� Signatures` , , " 4 ctJ�� Date f Z f