HomeMy WebLinkAbout6168 DOLAN CT - APPLICATIONS - 2/12/2019 (2)Planning, Development, & Transportation Services
f nFort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). WAir 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.
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Application #_ _k r__ '_A C)01gZ Date 0) lal�q
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
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Contractor City of t. Collins Sales Tax # Are you paying taxes here or by report?ere ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? 7K&es ❑ No
Is this a residential or co mercial project? Residential ❑ Commercial
If residential, is it: ngle Family Detac ed ❑ Condo/townhome (single family attached) El Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (exp am)
Is this building 50 years of age or more? El Yes) No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year wal the building constructed?
Description of work I. ,
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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 laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
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Applicant: LOW
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Print Name: I ll IEW Signature Date a o[
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Revision date 2/6/2017