HomeMy WebLinkAbout4306 CAPE COD CIR - APPLICATIONS - 3/27/2018:F`'oty of Planning, Development, & Transportation Services
rt CoUms Community Development & Neighborhood Services
- 281 North College Avenue
Fort Collins, CO B0524 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). M 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 informationon the application. Incomplete applications will not be accepted.
Application # �'9QoZQ `l/tDate
For ofce use only
Job Site Address (requi Value of C nstruction (labor, materials, profit)
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� rtyOwn.Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone Cq
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Contr ctor Address City/State Zip Phone (}
Contractor City of R. Colli Ies Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sales tax numberrsrequlredbyall mn&actors Are you paying with your trust account? p Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ® 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/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed efectridan.
Subcontractors: List the company name or City of Ft Collins license # 2 /�
Electrician Plumber Mechanical 1 Jl '- ( 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.I l lL IML •c M1411gnature �W1�1 �"� \ 7X 1 Date
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