HomeMy WebLinkAbout918 SANDY COVE LN - APPLICATIONS - 12/2/2016Fort 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
Demolition (interior non-structural) Electrical Alteration (not service change)
HeatingUnit .�onditi�ning
Lawn Sprinkler Mobile Home replacement g) Gas Lighter r"'Gas Log
Ventilation Water Heater Water Line Wood/Pellet Stove (moust e EPA certified, g Sewer lne provide make, and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #�� ( 4
For office use only Date i 1 t r
/ G f✓r� I �
Job Site Address (required) L / U y
Value of Construction (labor, materials, profit)
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Property Owner Name I 7 o 7 .,
Address 1 ? r U
rti rC'tY/State n n Zip Phone
Applicant Name I
1 Address
City/State ZIP Phone
Contractor Address
E_ra J F City/State Zip Phone
C Iry.�1�� �-i.•F�f'1,.� t�-Ik�i, i=1Jcl.=S:uCPti; (
Contractor City of Ft. Collins Sales Tax # ICu �2 ��,4 L
� 1 .✓
Are you paying taxes here or by report? Here G /
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Sales tax number is require by all contractors, t�2 0
Are you paying with your trust account? Yes No
is this a residential or commercial -project. CRes dentiah Commercial
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If residential, is it: Srngle_Famil - y Detached Condo/townhome (single family attached) Du
Multifamily (apartment) Garage P
lex
if commercal, is it: Bank Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explain),
Isthis building 50 years of age or more? Yes N�o�� If yes, ycu may need to contact Historic Presenafinn
If this is fora demolition permit, what year was th lding constructed?
If prior to 19i5, you wil/ need an asbestos assessment submit with th,;s application.
`ff lawn spri kler/backflow reventer, must list licensed lumber, I.
Subcontrarst-time A/ /ntVSt list licensed electrician.
<tors: List the company name or
Collins license
Elecrician `Y (J
(� ` Plumber '--� _
----�_ Mechanical
Roofer
'_ Other
— ----__
f 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.
QPPficant: I r`
Print Narne:
Signature
Date