HomeMy WebLinkAbout4913 LANGDALE CT - APPLICATIONS - 4/27/2016Cityof Planning, Development & Transportation
®Iw` Collinse281 N. College Ave P.O. Box 580
#
Fort Collins, CO 80524 —7C3
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 on -structural) ❑ Electrical Alteration (not service change) ❑.Gas Lighter ❑ Gas Log
❑ Heating Unit awn Sprinkler ❑ Mobile Home teplacement ❑ Roofing ❑ Sewer'Line ❑ Photo -voltaic
❑ Ventilation OdWater 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 # e) Iv v ( I
For office use only
Date`, y
Job Site Address (required)
Value of Construction (labor, materials, profit) i a-
G 12 14
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970 10� ifs
Property Owner Name
Address City/State Zip
Phone
M tj /ls � Ca�- �v
S Ct^12 S c-2 S 0"e
Applicant Name
Address City/State Zip
Phone
Contractor
Address City/State Zip
Phone
367 GJ. 1.c¢-s . & .'sosS 7
q7e�_, 116/ - G
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�comercial project? 2-Residential❑ Commercial
If residential, is it: 0-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 Ifyes, you mayneed 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: ^�`�
Print Name: We.( c- I allll42Signature
Date /, ZS
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