HomeMy WebLinkAbout907 SAILORS REEF - APPLICATIONS - 3/14/2016Planning, Dave[ �nt &Transportation
City/ Of 281 N. College Ave P:O. Box 580
Fort CoLLins 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 ❑ Photovoltaic
❑ Ventllation ❑ Water Heater El Water Line ❑ Woodipellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. incomplete applications will not be accepted.
Application # t?l 10 C) 1' ) 19
For office use only
job Site Address
Date ✓/ 1—`
(40
of Construction (labor, materials, profit)
:: 00
Property Owner Name Address City/State Zip
Applicant Name Address City/State zip
Contractor City of Ft. CoIM Sales Tax #
Sales tax number is Mulred by all contractors:
City/State zip
Are you paying with your trust account? s
P)3f-4-
hone
Phone
Phone
R.�,
❑ No
Is this a residential or commercial project? O.Residentlal ❑ Commercial
If residential, Is It: oSingle Family Detached ❑ Condo/tuwnhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 13 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes f)'No If yes, you may need to contact Hlstorlc Preswvatlon
If this is for a demolition permit, what year was the building constructed?
ifpr/or to t975, you will need an asbestos assessment to submit with this appilcadmi
ption 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 offr Collins license #
PlumberMedrldan
Mechanical RooferUfl 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 Issudd. /11 f)
Signature