HomeMy WebLinkAbout613 FOXTAIL ST - APPLICATIONS - 9/14/2018City of Planning, Development & Transportation
F} I 281 N. College Ave P.O. Box 580
t COIliI IS 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.
Application #
3 /Fa-4e-7i0q
For office use only
Date
Job Site Address (required
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Value of Construction (labor, materials, profit)
Property Owner Name
Address
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City/State Zip
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Phone
Applicant Name
Address
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City/State Zip
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Phone
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Contractor
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Address
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City/State Zip
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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 by all contractors.
Are you paying with your trust account? 0 Yes
❑ No
Is this a residential or mercial project? ®rF
If residential, is it: coRngle Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office , ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes U4o Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to.1975, you will need an asbestos assessment to submit with this application.
of work
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. a
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber.
Mechanical
— r 4 3 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: Lt�.111 ��(� Signature Date ��