HomeMy WebLinkAbout903 ELGIN CT - APPLICATIONS - 7/23/2018City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Foci 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 56 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 # & 1 ` /D4 (4(0 Date
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Job Site Address (required) value of Construction (labor, materials, profit)
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Property Owner ame Address City/State Zip Phone
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Applicant Name Ad ress City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? SH Here ❑ Report
Safer tax number is required contractors. Are you paying with your trust account? ❑ Yes JZNo
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Is this a residential or commercial project? Eg Residential ❑ Commercial
If residential, is it: 4 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 mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
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*If lawn spri Kier/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or Gil of Ft Collins license # 1,L-VW
Dectrician Plumber Mechanical Roofer !f 0'I'IOther
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: Ci)Il,r�t/1 S41(U/� C�('Jyl.W! G% VLLG
Print Name: Signature � �^�• Date
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