HomeMy WebLinkAbout445 HOUGHTON CT - APPLICATIONS - 8/1/2018ra.-I) V/
Fort 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 Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement V 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.
Application # 1p-)l
For tice use only
Incomplete applications will not b ccepted.
Date -),I
Job Site Address (required)
141 Z--Value of Construction' (labor, materials, profit)
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Property Owner Name
Address City/State Zip Phone
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Applicant Name
Address City/State Zip Phone
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? -A sere ❑ Report
Sales tax number is required bya/lmnbactols Are you paying with your trust account? ❑ Yes No
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Is this a residential or com�mercial project? H 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 (expla;n)
Is this building 50 years of age or more? ❑ Yes H No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # p t
Electrician Plumber Mechanical Roofer 11 as 13 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, 4 Q