HomeMy WebLinkAbout4307 REVERE CT - APPLICATIONS - 2/18/2016FEB/18/2016/THU 11:24 AM FAX No, P,002
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C(.y o f Planning, Development & Transportation
�] 281 N. College Ave P.O. Box 580
6rt Collins Fort Collins, CO BOS24
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMIT'S ONLY
This application is to be used to apply for the following permits only (check all that apply). Q Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit Lawn Sprinkler ❑ Mobile Home replacement ❑ Rooting ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation t9Water Heater la 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
For office use only
Job Site Address (mquired) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/state Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
sales taxnirerignd by all contranors y� Are you paying with your trust account? Wyes ❑ No
Is this a residential or commercial project? P1 Residential 11 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/Mote) ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explairyry)
Is this building 50 years of age or more? ❑ Yes 1VNo If yes, you may need to contact Historic preservation
If this Is for a demolition permit, what year was the building constructed?
Ifprior 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 Gty of At 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: i$ %V
Print Name: rJ 1 signature �..11 Data