HomeMy WebLinkAbout427 STONEY BROOK RD - APPLICATIONS - 9/20/2019Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
/ Phone 970-41672740 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 ❑ 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 # l � 11 Lag 14 Date 9,& 0?
For office use only
Job Site Address (required)
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Value of Construction (labor, materials, profit)
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Properly Owner Name
Address
City/State Zip Phone
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Name
Address
City/State Zip Phone
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Contractor
Address
City/State Zip Phone
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Tax #
Are you paying taxes here or by report? ;X Here ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes UrNo
Is this a residential or commercial project? 4 Residential ❑ Commercial
If residential, is it: 0 Single Family Detached ❑ 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 ❑ No If yes, you may need to contact Historic Preservation
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/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:�L�Li11U4 C`P Signature Date