HomeMy WebLinkAbout2915 COUNTY FAIR LN - APPLICATIONS - 7/11/2016Jul 11 16 01:57p FyrePro
9702253870 p.1
oft Corns
Planning, Development & To tation
281 N. College Ave P.O. Bo, 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 ., L7 Gas Leg jrj r`
❑ Heating Unit ❑ Lawn Sprinkler ❑ h4obile Home replacement ❑ Roofing ❑ Sewer Line., ElPhoto-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 �Arill na` b
Application 4dr'- 5 ILP6 31-71
For oince use only
Job Site Address (required)
15/5
c
Properly Owner Name Address
Applicant Name
Lic #t
IL
Contractor City of Ft. Collins Sales Tax T
Sales tax number is required by all contactors
y a aocepsed.
Date
Value of Construction (labor, materials, profit)
City/State
Zip Phone
r
r Address _-- City/Statezio
f
_ `- :�. `=} • �' � _ -. _ -ram • � '� r .
Address City/State 1 Zip,-
f`. --� r� ��' "•%E - , f f 1 i .ram. �.L`..•_:�--%� : ��:�`C(
Phone
J
Phone
J G)
Are you paying taxes here or by report? O Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 17 Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family at—, ached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
if commercial, is it: D Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office L7 Retail
❑ Restaurant ❑ Other (explain)
is this building 50 Years of age or more? ❑ Yes Z No lfyes, 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 tc submit w1r17 this application.
of
:"If lawn sprinkler/backflow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician.
Subcont,Aactors:' 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 unfB it has been paid and issued.
,'applicant: i
Print Name: _mil l",'? / r.. / .r L•%�: -c...
r
Date