HomeMy WebLinkAbout955 BUNGALOW CT - APPLICATIONS - 7/21/2016City of
Fort Collins
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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 theme` application. Incomplete applications will n1,
otbe accepted.
Application # B I VI 0'12y Date L`
For ofce use only
Job Site Address (required)
lue of Construction (labor, materials,
profit) GQ3
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Property Owner Name r �dclress
City/State Zip
Phone
Ap a Address
ity/State Zip
Phone
Contra o�r l /,Address
COQity at . Zip
Phone
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Contractor City off Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
Sales tax number isrequi by all contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or co mercial project? ❑ Residential ❑ Commercial
If residential, is it: EX Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotei/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Oth (explain)
Is this building 50 years of age or more? Nf Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If priorto 1975, you will need an asbestos assessment to submit with this application.
Description of work
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*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 I ting building construction. I know that a
permit is not valid until it has been paid and issued.
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Applicant:, r \
print Name: 0( 1k Signature \ 0ate�
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