HomeMy WebLinkAbout625 MANSFIELD DR - APPLICATIONS - 7/31/2018C4 Of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
'281 North College Avenue
Fort Collins, CO 60524 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 servic change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler El Mobile Home replacement 6Roofing ❑ 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 #. rJ����2� ` Date
For ofce use only
lob Site Address (required) Value of Construction (labor, materials, profit)
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Property,Owner Name Address City/State Zip Phone
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Applicant
7Name Address City/State Zip 7 Phone
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Contractor Address ity/State Zip Phone
Contractor City. of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑.Report
Sales tax number Is required by all contractors. Are you paying with your trust account? Gales ❑ No
Is this a residential or c mmercial project? Residential ❑ Commercial
If residential, is it: 13 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 (expl in)
Isthisbuilding 50 years of age or more? ❑ Yes Cd No If yes, you may need to contact Historic Preservation
If this is for a demolitionpermit, what.year was the building constructed?
Description of work CCqnC-\ Co 1 �.�+� ---n
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed. electrician.
Subcontractors: List the company name or Gty of Ft Collins license # ,A
Electrician Plumber Mechanical Roofer a 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 re ulating building constriction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
I / *�G Signature Date
Revlslon.date M2017 '