HomeMy WebLinkAbout4229 BREAKWATER CT - APPLICATIONS - 9/16/2019Fort 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log 1 Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 # `JI V I I Iyn �) Date
For office use only
Job Site Address (required) ��
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Property Owner Name Address
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City/State Zip Phone
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Applicant Name -Address
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Contractor � u� /�ddl• ss
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Contractor City of Ft. Collins SaQ Tax #
Are you paying taxes here or by report? KHere ❑ Report
Sales tax number isrequiredbyallcontractors.33n RA
Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact HistorlcPreser✓atlon
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/Cr must list licensed electrician.
Subcontractors: List the company name or City of Ft collins license #
Electrician Plumber Mechanical r 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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