HomeMy WebLinkAbout606 LOCUST GROVE DR - APPLICATIONS - 7/11/2017Fort Collins
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 the application. Incomplete applications will not be accepted.
�1I Application # `Ts `+��� Date
For ofte use only
Job Site Address (required)
Value of.Construction (labor, material profit)
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Property Owner Name Ad ress
City/State Zip Phone
Applicant Name Address
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City/State Zip Phone
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Co tractor . Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # .
Are you paying taxes here or by report? Here ❑ Report
Sales tax number is required byall contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or ommercial project? Residential ❑ Commercial
If residential, is it: Single Family Detac4d ❑ 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 'O No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? N d
If prior to 1975, you w111 need an asbestos assessment to submit with this application.
Description of
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*If lawn sprinkler/backnow 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: J tis tA Signatu Date