HomeMy WebLinkAbout4306 CAPE COD CIR - APPLICATIONS - 4/30/2018Planning, Development, & Transportation Services
Fort 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). ❑ 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 information on the application. Incomplete applications will not be accepted.
Application # hko lbY� Date
For oH`ice use only
Job Site Address(requi ) Value of Con udJon labor, materials, profit)
Property Owner% Name Address Gty/State Zip Phone
Applicant Name - Address _ City/State Zip Phone MA
Address
Contractor City of R. Colliris-tales Tax #
Sales tax number Is required by all contractors. llb\Ct CU
Are you paying taxes here or by report? ❑ Here ■ Report
Are you paying with your trust account? 10 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/badcFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Wbm 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 clty ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
Applicant:
int PrName �KWIi KWICQ01 iL41gnature
Romman Bete 21612017
Date