Building Permit Application

COMMUNITY Development & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
APPLICATION NUMBER______________________________________
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
NUMBER______________________________________
NUMBER______________________________________
NUMBER______________________________________
NUMBER______________________________________
APPLICATION
APPLICATION
APPLICATION
APPLICATION
DATE_____________________________________________
APPLICATION
NUMBER__________________________________________
APPLICATION
DATE________________________________________
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
NUMBER______________________________________
NUMBER______________________________________
NUMBER______________________________________
NUMBER______________________________________
NUMBER______________________________________
NUMBER______________________________________
NUMBER______________________________________
NUMBER______________________________________
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
APPLICATION
NUMBER______________________________________
APPLICATION
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
APPLICATION
NUMBER______________________________________
APPLICATION
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
DATE_____________________________________________
JobJob
SiteSite
Address_________________________________________
UnitUnit
#______________________
Job
Job
Site
Site
Address_________________________________________
Job
Address_________________________________________
Address_________________________________________
Site Address_________________________________________
Unit
Unit
#______________________
#______________________
#______________________
Unit #__________________
Job
Job
Job
Site
Job
Job
Job
Site
Site
Address_________________________________________
Site
Site
Site
Address_________________________________________
Address_________________________________________
Address_________________________________________
Address_________________________________________
Address_________________________________________
Address_________________________________________
Unit
Unit
Unit
Unit
#______________________
Unit
Unit
Unit
#______________________
#______________________
#______________________
#______________________
#______________________
#______________________
#______________________
Site
Address_________________________________________
Unit
#______________________
Job
Site
Address_________________________________________
Unit
#______________________
PROPERTY OWNER INFO: (All owner information is required – it is not optional) Phone #_______________________________________
PROPERTY
PROPERTY
PROPERTY
OWNER
PROPERTY
OWNER
OWNER
INFO
INFO
OWNER
:INFO
: (All
(All:owner
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(All owner
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:information
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Phone
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) Phone
#_______________________________________
#_______________________________________
) Phone
#_______________________________________
#_________________________________
PROPERTY
PROPERTY
PROPERTY
PROPERTY
PROPERTY
PROPERTY
PROPERTY
PROPERTY
OWNER
OWNER
OWNER
OWNER
OWNER
OWNER
OWNER
OWNER
INFO
INFO
INFO
INFO
INFO
: ::INFO
INFO
(All
:INFO
(All
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: :owner
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Phone
)))) Phone
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Phone
#_______________________________________
Phone
#_______________________________________
#_______________________________________
#_______________________________________
#_______________________________________
#_______________________________________
#_______________________________________
#_______________________________________
PROPERTY
OWNER
INFO
(All
owner
information
is
required
––is
it–
is
not
optional
Phone
#_______________________________________
PROPERTY
OWNER INFO: (All owner information isFirst
required
– it is not optional) Phone #_______________________________________
Last
name________________________________
Name_____________________________
Middle
__________________________
Last
Last
name________________________________
name________________________________
Last name________________________________
Last name________________________________
First
FirstName_____________________________
Name_____________________________
First
Name_____________________________
First Name_____________________________
Middle
Middle
Middle
__________________________
__________________________
__________________________
Middle ____________________
Last
Last
Last
Last
name________________________________
name________________________________
Last
Last
name________________________________
name________________________________
name________________________________
Last
name________________________________
name________________________________
name________________________________
First
First
First
First
First
Name_____________________________
Name_____________________________
First
First
Name_____________________________
Name_____________________________
First
Name_____________________________
Name_____________________________
Name_____________________________
Name_____________________________
Middle
Middle
Middle
Middle
Middle
Middle
__________________________
Middle
Middle
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
Last
name________________________________
First
Name_____________________________
Middle
__________________________
Last
name________________________________
First
Name_____________________________
Middle
__________________________
StreetStreet
Address__________________________________________
City___________________________
State________Zip____________
Street
Street
Address__________________________________________
Address__________________________________________
Address__________________________________________
Street Address__________________________________________
City___________________________
City___________________________
City___________________________
City___________________________
State________Zip____________
State________Zip____________
State________Zip___________
State________Zip______
Street
Street
Street
Street
Address__________________________________________
Street
Address__________________________________________
Street
Street
Address__________________________________________
Address__________________________________________
Address__________________________________________
Address__________________________________________
Address__________________________________________
Address__________________________________________
City___________________________
City___________________________
City___________________________
City___________________________
City___________________________
City___________________________
City___________________________
City___________________________
State________Zip____________
State________Zip____________
State________Zip____________
State________Zip____________
State________Zip____________
State________Zip____________
State________Zip____________
State________Zip____________
Street
Address__________________________________________
City___________________________
State________Zip____________
Street Address__________________________________________
City___________________________
State________Zip____________
INFO:INFO:
Company
Name
__________________________________
Contractor
Phone
#______________________________
CONTRACTOR
INFO:
Company
Company
INFO:
Name
Company
Name
__________________________________
__________________________________
Name __________________________________
Contractor
Contractor
Phone
Contractor
Phone
#______________________________
#____________________________
Phone #_______________________
Company
Name
__________________________________
Contractor
Phone
#______________________________
CONTRACTOR
CONTRACTOR
CONTRACTOR
CONTRACTOR
INFO:
INFO:
INFO:
INFO:
INFO:
INFO:
Company
INFO:
INFO:
Company
INFO:
Company
Company
Company
Company
Company
Name
Name
Name
Name
Name
__________________________________
Name
Name
__________________________________
Name
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
Contractor
Contractor
Contractor
Contractor
Contractor
Contractor
Contractor
Contractor
Phone
Phone
Phone
Phone
Phone
Phone
#______________________________
Phone
Phone
#______________________________
#______________________________
#______________________________
#______________________________
#______________________________
#______________________________
#_____________________________
CONTRACTOR
CONTRACTOR
CONTRACTOR
CONTRACTOR
CONTRACTOR
CONTRACTOR
CONTRACTOR
CONTRACTOR
INFO:
Company
Name
__________________________________
Contractor
Phone
#______________________________
CONTRACTOR
INFO:
Company Name __________________________________
Contractor
Phone #______________________________
CONTRACTOR
Lic
Holder
Name
_____________________________________
Cityof
of
Fort
Collins
License
#___________
Supervisor
Cert
#___________
Lic
Holder
Lic Holder
Name
Lic Name
Holder
_____________________________________
_____________________________________
Name _____________________________________
City
City
Fort
ofCollins
Fort
City Collins
ofLicense
Fort Collins
License
#___________
License
#___________
#___________
Supervisor
Supervisor
Cert
Supervisor
#___________
Cert #___________
Cert #_____
Lic
Holder
Name
_____________________________________
City
of
Fort
Collins
License
#___________
Supervisor
Cert
#___________
Lic
Lic
Holder
Holder
Holder
Lic
Holder
Lic
Lic
Holder
Name
Holder
Name
Holder
Name
Name
Name
_____________________________________
Name
_____________________________________
Name
Name
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
City
City
City
City
City
of of
City
Fort
of
City
of
City
of
Fort
Fort
Fort
of
Fort
Collins
ofof
Fort
Collins
Fort
Collins
Collins
Fort
Collins
Collins
Collins
License
Collins
License
License
License
License
License
License
#___________
License
#___________
#___________
#___________
#___________
#___________
#___________
#___________
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Supervisor
Cert
Cert
Cert
#___________
Cert
Cert
Cert
#___________
#___________
#___________
Cert
#___________
#___________
#___________
#___________
LicLic
Holder
Name
_____________________________________
City
of
Fort
Collins
License
#___________
Supervisor
Cert
#___________
Lic Holder
Name _____________________________________ City City____________________
of Fort Collins License #___________
Supervisor Cert
#___________
Mailing
Address________________________________________
State____________
Zip________________
Mailing
Mailing
Address________________________________________
Mailing
Address________________________________________
Address________________________________________
City____________________
City____________________
City____________________
State____________
State____________
State____________
Zip________________
Zip_______________
Zip_________
Mailing
Address________________________________________
City____________________
State____________
Zip________________
Mailing
Mailing
Mailing
Mailing
Mailing
Mailing
Address________________________________________
Address________________________________________
Mailing
Address________________________________________
Address________________________________________
Address________________________________________
Address________________________________________
Address________________________________________
Address________________________________________
City____________________
City____________________
City____________________
City____________________
City____________________
City____________________
City____________________
City____________________
State____________
State____________
State____________
State____________
State____________
State____________
State____________
State____________
Zip________________
Zip________________
Zip________________
Zip________________
Zip________________
Zip________________
Zip________________
Zip________________
Mailing
Address________________________________________
City____________________
State____________
Zip________________
Mailing INFO:
Address________________________________________ City____________________ State____________ Zip________________
LEGAL
LEGAL
LEGAL
INFO:
LEGAL
INFO: INFO:
LEGAL
INFO:
LEGAL
LEGAL
LEGAL
LEGAL
LEGAL
LEGAL
INFO:
LEGAL
INFO:
INFO:
INFO:
INFO:
INFO:
INFO:
INFO:
LEGAL
INFO:
LEGAL INFO:
Subdivision/PUD__________________________________
FilingFiling
#__________
Lot#________
#________
BlockBlock
#_______
Lot
Sq
Ft_____________
Subdivision/PUD__________________________________
Filing
#__________
Lot
#________
Block
#_______
Lot
Sq
Ft_____________
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Filing
#__________
#__________
Filing #__________
Lot
Lot #________
LotBlock
#________
#_______
#_______
Block
Lot
#_______
Sq
Lot
Ft_____________
Sq Ft_____________
Lot Sq Ft_______
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Subdivision/PUD__________________________________
Filing
Filing
Filing
Filing
Filing
#__________
Filing
Filing
#__________
Filing
#__________
#__________
#__________
#__________
#__________
#__________
LotLot
Lot
Lot
#________
Lot
#________
Lot
#________
Lot
Lot
#________
#________
#________
#________
Block
Block
Block
Block
Block
#_______
Block
Block
Block
#_______
#_______
#_______
#_______
#_______
#_______
#_______
LotLot
Lot
SqLot
Sq
Lot
Ft_____________
Sq
Lot
Lot
Sq
Ft_____________
Sq
Ft_____________
Ft_____________
Sq
Sq
Ft_____________
Ft_____________
Ft_____________
Ft_____________
Subdivision/PUD__________________________________
Filing
#__________
Lot
#________
Block
#_______
Lot
Sq
Ft_____________
Subdivision/PUD__________________________________
Filing #__________ Lot #________ Block #_______ Lot Sq Ft_____________
(not including basement)__________________________ Total Garage Sq Ft ________________
CONSTRUCTION
INFO:INFO:
TotalINFO:
Building
SqFt
Ft
CONSTRUCTION
INFO:
Total
Building
Sq
Ft
(not
(notFt
including
including
(not
basement
basement
(not including
basement
)__________________________
)__________________________
basement
)__________________________
)__________________________
Total
TotalGarage
Total
Garage
Garage
Total
Sq
SqFt
Ft
Garage
Sq
________________
________________
Ft ________________
Sq Ft __________
CONSTRUCTION
CONSTRUCTION
CONSTRUCTION
INFO:
Total
Building
Total
Building
Total
Sq
Building
Sq
Sqincluding
Ft
(not
(not
(not
including
(not
including
including
(not
including
(not
including
(not
including
including
basement
including
basement
basement
basement
basement
basement
basement
)__________________________
basement
)__________________________
)__________________________
)__________________________
)__________________________
)__________________________
)__________________________
)__________________________
Total
Total
Total
Total
Total
Garage
Total
Total
Garage
Total
Garage
Garage
Garage
Garage
Garage
Sq
Garage
Sq
Sq
Ft
________________
Ft
Sq
Ft
Sq
Sq
________________
Ft
________________
________________
Ft
Ft________________
Ft
________________
________________
________________
CONSTRUCTION
CONSTRUCTION
CONSTRUCTION
CONSTRUCTION
CONSTRUCTION
CONSTRUCTION
CONSTRUCTION
CONSTRUCTION
INFO:
INFO:
INFO:
INFO:
INFO:
INFO:
INFO:
Total
INFO:
Total
Total
Total
Building
Building
Total
Total
Building
Total
Building
Building
Building
Building
Building
Sq
Sq
Sq
Ft
Sq
Sq
Ft
Ft
Sq
Ft
Ft
Sq
Sq
Ft
Ft
Ft
(not
including
basement
)__________________________
Total
Garage
SqSq
Ft
________________
CONSTRUCTION
INFO:
Total
Building
Sq
Ft(not
)__________________________
Total Garage
Sq
Ft ________________
CONSTRUCTION
INFO: TotalComm’l
BuildingSq
SqFt_____________
Ft (not including basement
Residential
Sq
FtSq
__________
#of
ofStories_______
Stories_______
BldgHeight__________
Height__________
Dwelling
Units
___________
Residential
Residential
Residential
Sq
Sq
Residential
Ft
Ft
__________
__________
Ft __________
Sq Ft __________
Comm’l
Comm’l
Comm’l
Sq
SqFt_____________
Ft_____________
Comm’l
Sq Ft_____________
Sq Ft_____________
##
of
Stories_______
# of Stories_______
# of Stories_______
Bldg
Bldg
Bldg
Height__________
Height__________
Bldg Height__________
###Dwelling
Dwelling
# Dwelling
Units
Units
# Dwelling
___________
Units
___________
___________
Units _____
Residential
Residential
Residential
Residential
Residential
Residential
Residential
Sq
SqSq
Sq
Ft
Sq
Ft__________
Ft
Ft
__________
Sq
Ft
Sq
Sq
__________
__________
__________
Ft
FtFt
__________
__________
__________
Comm’l
Comm’l
Comm’l
Comm’l
Comm’l
Comm’l
Comm’l
Sq
Comm’l
Sq
Sq
Ft_____________
Sq
Sq
Ft_____________
Ft_____________
Sq
Ft_____________
Ft_____________
Sq
Sq
Ft_____________
Ft_____________
Ft_____________
##
of
#
Stories_______
of
ofof
Stories_______
#Stories_______
#Stories_______
#
of
Stories_______
ofof
Stories_______
Stories_______
Stories_______
Bldg
Bldg
Bldg
Bldg
Bldg
Height__________
Bldg
Bldg
Height__________
Height__________
Bldg
Height__________
Height__________
Height__________
Height__________
Height__________
# Dwelling
###
#Dwelling
Dwelling
Dwelling
###Dwelling
Dwelling
#Dwelling
Dwelling
Units
Units
Units
___________
Units
Units
Units
___________
Units
___________
___________
___________
___________
___________
___________
Residential
Sq
Ft
__________
Comm’l
Sq
Ft_____________
###of
of
Stories_______
Bldg
Height__________
Dwelling
Units
___________
st
nd
rd# of Stories_______ Bldg Height__________ # Dwelling Units ___________
Sq
Ft __________2ndnd
Comm’l
SqFtFt_____________
Sq
Ft
Floor
Sq
Floor
Sq
1stResidential
st Floor
st___________
nd___________ 3
rd __________ Unfinished Bsmt Sq Ft____________
st
rd Ft
Floor
Floor
Sq
Ft
Sq
___________
Floor
Ft ___________
Sq Ft ___________
22ndnd
Floor
Floor
2ndndndndFloor
Sq
Floor
Sq
Ft
Ft
2Sq
___________
Sq
___________
Floor
Ft _______________
___________
Sq Ft ___________
33rdrdrd
Floor
3rdrdrd rd Sq
Floor
Sq
3
Ft
Ft
Sq
__________
__________
Floor
Ft __________
Ft __________
Unfinished
Unfinished
Unfinished
Bsmt
Bsmt
Unfinished
Sq
Bsmt
SqFt____________
Ft____________
Sq
Bsmt
Ft____________
SqFtFt____________
11
1
1st Sq
1___________
Floor
Sq
Ft
_______________
Ft
3
Floor
Sq
FtSq
_______________
Unfiished
Bsmt
Sq
______________
st
stFloor
st
st Ft
nd2
nd
rdrdFloor
nd
Floor
Floor
Sq
Floor
Floor
Sq
Floor
Ft
Sq
Ft ___________
Ft
Ft
___________
Ft
Sq
Sq
___________
Sq
___________
___________
Ft
FtFt
___________
___________
___________
22
2Floor
2ndFloor
Floor
2
Floor
22Sq
Sq
Floor
Floor
Sq
Floor
Ft
Sq
Sq
Ft
Ft
Ft
Sq
Ft
___________
Sq
___________
Sq
___________
___________
Ft
FtFt
___________
___________
___________
3rd3
3rdFloor
Floor
33Floor
Floor
3Sq
Floor
Floor
Sq
Sq
Floor
Ft
Sq
Sq
Ft
__________
Ft
Sq
Ft
Sq
Ft
__________
Sq
__________
__________
Ft
Ft
__________
Ft
__________
__________
__________
Unfinished
Unfinished
Unfinished
Unfinished
Unfinished
Unfinished
Unfinished
Bsmt
Bsmt
Bsmt
Bsmt
Bsmt
Sq
Bsmt
Bsmt
Sq
Bsmt
Sq
Ft____________
SqSq
Ft____________
Ft____________
Sq
Ft____________
Sq
Sq
Ft____________
Ft____________
Ft____________
Ft____________
1
1ststFloor
11stSq
1
Floor
Sq
Ft
___________
2nd
Floor
Sq
Ft___________
___________
3rd3rd3Floor
Floor
Sq
Ft
__________
Unfinished
Bsmt
Sq
Ft____________
1stst1Floor
Ft ___________
2 Floor
Ft ___________
3of Full
Floor
Sq Ft_____
__________
Unfinished
Bsmt Sq
Ft____________
1 Floor Sq
Finished
Bsmt
SqFt
FtSq
__________
#of
ofSq
Bedrooms
_____
#of
Baths
¾Baths
Baths
_____
½Baths
Baths
_____
ofFireplaces
Fireplaces
_____
Finished
Finished
Finished
Bsmt
Bsmt
Finished
Sq
Bsmt
Sq
Ft
__________
__________
Bsmt
Ft __________
Sq Ft __________
##
of
Bedrooms
Bedrooms
# of Bedrooms
# of
_____
_____
Bedrooms
_____
##
ofFull
Full
_____
# ofBaths
Baths
Full# Baths
of
_____
_____
Full_____
Baths
¾
¾
Baths
_____
¾ Baths
_____
_____
¾_____
Baths
½
½
Baths
_____
½ Baths
_____
_____
½ _____
Baths
###of
of
Fireplaces
#_____
of Fireplaces
# of
_____
_____
Fireplaces
_____ ___
Finished
Finished
Finished
Finished
Finished
Finished
Finished
Bsmt
Bsmt
Bsmt
Bsmt
Bsmt
Sq
Sq
Bsmt
Bsmt
Sq
Bsmt
Sq
Ft
Sq
Ft
__________
Ft
Ft
__________
Sq
Ft
Sq
Sq
__________
__________
__________
Ft
Ft
Ft
__________
__________
__________
#
#
of
#
of
#
Bedrooms
of
of
Bedrooms
#
Bedrooms
#
Bedrooms
Bedrooms
#
of
of
of
Bedrooms
Bedrooms
Bedrooms
_____
_____
_____
_____
_____
_____
_____
#
_____
#
of
#
#
of
#
Full
of
of
of
Full
#
Full
#
Full
#
of
Baths
Full
of
of
Baths
Full
Baths
Full
Baths
Full
Baths
_____
Baths
Baths
_____
Baths
_____
_____
_____
_____
_____
¾
_____
¾
Baths
¾
¾
¾
Baths
Baths
Baths
¾
¾
Baths
¾
_____
Baths
Baths
Baths
_____
_____
_____
_____
_____
½
_____
Baths
½
½
Baths
½
Baths
Baths
½
½
Baths
½
Baths
_____
Baths
Baths
_____
_____
_____
_____
_____
#_____
_____
of###Fireplaces
of
of
##Fireplaces
#of
Fireplaces
of
#ofFireplaces
of
Fireplaces
Fireplaces
Fireplaces
_____
_____
_____
_____
_____
_____
_____
_____
Finished Bsmt Sq Ft __________ # of Bedrooms _____ # of Full Baths _____ ¾ Baths _____ ½ Baths _____
of
Fireplaces
_____
Finished
Bsmt
Sq
Ft
__________
#
of
Bedrooms
_____
#
of
Full
Baths
_____
¾
Baths
_____
½
Baths
_____
#
of
Fireplaces
_____
Circle appropriate choice )
1.)ComCheck
ComCheck
2.ResCheck
ResCheck
w/Air
Sealing
AirConditioning:
Conditioning:
Yes Yes
No No
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Yes
Yes
No
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Yes Energy
Energy
No Energy
info:
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Air
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Conditioning:
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YesNo
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4.
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4.4.
4.
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4.
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5.
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5.
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w/Air
w/Air
w/Air
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w/Air
w/Air
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w/Air
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6. Prescriptive
6.
6.
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6.
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6.
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6.
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w/ w/
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w/
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Blower
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5.
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6.
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5. Prescriptive w/Air Sealing
6. Prescriptive w/ Blower Door
Cityof
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#Stock
_____________________
Listappropriate
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#s__________________________________________
City
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UTILITIES
INFO:
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UTILITIES
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UTILITIES
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UTILITIES
INFO:
INFO:
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UTILITIES
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Water
TapSize
Size
___________
Sewer
TapSize
Size
___________
Metered:
Yes
or No
No
Temp.
Pedestal
Yes
or No
No
Water
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___________
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___________
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___________
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Metered:
Metered:
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___________
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___________
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___________
___________
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___________
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Metered:
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Metered:
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orYes
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___________
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___________
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Yes
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Size
___________
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Size
___________
Metered:
Yes
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Temp.
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Yes
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Typeof
ofHeat:
Heat:
Gas
Gas
Electric
Electric
MainElectric
Breaker
SizeBreaker
(Residential
only) only)
150Amp
Amp
or150
Less
200
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Other
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150
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Amp
or
Less
Less
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200
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Gas
Gas
Gas
Gas
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Electric
Electric
Electric
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Electric
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150
150
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150
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Amp
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Other
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Other
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Type
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Electric
Main
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150
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200
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Other
Type of Heat:  Gas  Electric
Electric Main Breaker Size (Residential only) 150 Amp or Less
200 Amp  Other
ValueValue
ofConstruction
Construction
(including
labor,
material
&profit)
profit)
$__________________________________________________________________
Value
Value
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Construction
ofValue
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(including
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$__________________________________________________________________
$__________________________________________________________________
& $_________________________________________________________________
profit) $____________________________________________________________
Value
Value
Value
Value
of
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Value
Value
Value
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$__________________________________________________________________
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$__________________________________________________________________
$__________________________________________________________________
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$__________________________________________________________________
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$__________________________________________________________________
Value
of
Construction
(including
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profit)
$__________________________________________________________________
Value of Construction (including labor, material & profit) $__________________________________________________________________
Description
of
Work
:_____________________________________________________________________________________
Description
Description
Description
of
of
Description
Work
Work
of:_____________________________________________________________________________________
Work
of
Work:_________________________________________________________________________________
:_____________________________________________________________________________________
:_____________________________________________________________________________________
Description
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Description
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Description
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of
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:_____________________________________________________________________________________
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:_____________________________________________________________________________________
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:_____________________________________________________________________________________
Description
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:_____________________________________________________________________________________
_____________________________________________________________________________________
Description
of Work:_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
_______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
_______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
_______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Contact Name & Phone # of JOBSITE SUPERVISOR: _____________________________________________________________________
Contact
Contact
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Name
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Contact
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&&Phone
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______________________________________________________________
Contact
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Contact
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Contact Name &Info:
Phone # of JOBSITE SUPERVISOR: _____________________________________________________________________
Subcontractor
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Info: Info: Info:
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Subcontractor Info:
Subcontractor
Info:
Electrical
___________________________
Mechanical
______________________________
Plumbing
___________________________
Electrical
Electrical
Electrical
___________________________
___________________________
Electrical
___________________________
___________________________
Mechanical
Mechanical
Mechanical
______________________________
______________________________
Mechanical
______________________________
______________________________
Plumbing
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___________________________
___________________________
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___________________________
_____________________
Electrical
___________________________
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______________________________
Plumbing
___________________________
Electrical
Electrical
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___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
Mechanical
Mechanical
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______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
Plumbing
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___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
Electrical
___________________________
Mechanical
______________________________
Plumbing
___________________________
Electrical
___________________________
Mechanical ______________________________
Plumbing ___________________________
Framer
____________________
Roofing
____________________
Concrete
____________________
Fireplace
_____________________
____________________
Concrete
____________________
Fireplace
_____________________
Framer
Framer
Framer
____________________
____________________
Framer
____________________
____________________
Roofing
Roofing
Roofing
____________________
Roofing
____________________
____________________
Concrete
Concrete
____________________
Concrete
____________________
____________________
Fireplace
Fireplace
_____________________
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_____________________
_______________
Framer
____________________
Roofing
____________________
Concrete
____________________
Fireplace
_____________________
Framer
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____________________
Framer
____________________
____________________
____________________
____________________
____________________
____________________
Roofing
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____________________
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____________________
____________________
____________________
____________________
____________________
____________________
Concrete
Concrete
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Concrete
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Fireplace
Fireplace
Fireplace
Fireplace
Fireplace
Fireplace
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_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Framer ____________________ Roofing ____________________ Concrete ____________________
Fireplace
_____________________
Framer
____________________
Roofing
____________________
Concrete
____________________
Fireplace
_____________________
SolarSolar
______________________
OtherOther
______________________
OtherOther
_____________________
OtherOther
_____________________
Solar
Solar
______________________
______________________
______________________
Solar ______________________
Other
Other
______________________
______________________
______________________
Other ______________________
Other
Other
_____________________
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Solar
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______________________
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Other
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Solar
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______________________
Other
______________________
Other
_____________________
Other
_____________________
Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
Applicant:
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requirements
all
requirements
requirements
all
allall
requirements
requirements
requirements
requirements
Applicant:
hereby
acknowledge
that
have
read
this
application
and
state
that
the
above
information
isiscorrect
correct
and
agree
to
comply
with
all
requirements
contained
contained
contained
herein
herein
herein
and
and
City
and
herein
ofof
City
Fort
Fort
and
of
Collins
Collins
Fort
City
ordinances
of
ordinances
Fort
Collins
and
and
ordinances
state
state
and
laws
laws
state
and
regulating
regulating
laws
state
regulating
laws
building
building
regulating
building
construction.
construction.
building
construction.
Applicant:
I herein
hereby
acknowledge
that
I Collins
have
read
this
application
and
state
that
the
above
information
is correct and agree to comply with all requirements
contained
contained
contained
contained
contained
contained
contained
herein
herein
herein
herein
and
and
herein
herein
herein
and
and
and
City
City
City
and
City
and
City
of
and
of
Fort
of
City
Fort
of
City
of
City
Fort
Fort
Collins
of
Collins
of
of
Fort
Collins
Fort
Collins
Fort
ordinances
Collins
Collins
ordinances
Collins
ordinances
ordinances
ordinances
ordinances
ordinances
ordinances
and
and
and
and
state
and
state
state
and
and
state
state
and
laws
laws
state
state
laws
laws
state
laws
regulating
regulating
laws
regulating
laws
regulating
laws
regulating
regulating
regulating
regulating
building
building
building
building
building
building
building
construction.
building
construction.
construction.
construction.
construction.
construction.
construction.
construction.
contained herein and City of Fort Collins ordinances and state laws regulating building construction.
contained herein
and City of Fort Collins ordinances and state laws regulating
building
construction.
Applicant
Signature___________________________________
Print
Name___________________________
Phone __________________
Applicant
Applicant
Applicant
Signature___________________________________
Signature___________________________________
Applicant
Signature___________________________________
Signature___________________________________
Print
PrintName___________________________
Print
Name___________________________
Name___________________________
Print Name___________________________
Phone
Phone
Phone
__________________
__________________
_________________
Phone ___________
Applicant
Applicant
Applicant
Applicant
Applicant
Applicant
Applicant
Signature___________________________________
Signature___________________________________
Signature___________________________________
Signature___________________________________
Signature___________________________________
Signature___________________________________
Signature___________________________________
Signature___________________________________
Print
Print
Print
Print
Print
Name___________________________
Print
Name___________________________
Print
Name___________________________
Print
Name___________________________
Name___________________________
Name___________________________
Name___________________________
Name___________________________
Phone
Phone
Phone
Phone
Phone
Phone
__________________
Phone
Phone
__________________
__________________
__________________
__________________
__________________
__________________
__________________
Applicant
Signature___________________________________
Print
Name___________________________
Phone
__________________
Applicant Signature___________________________________
Print
Name___________________________
Phone
__________________
Distribution:
White – Office Yellow – Applicant
Pink – WWW/Stormwater
Distribution:
Distribution:
Distribution:
Distribution:
White
White–
White
–Office
Office
– White
Office
Yellow
Yellow
– Office
Yellow
––Applicant
Applicant
–Yellow
Applicant
–Pink
Pink
Applicant
––Pink
WWW/Stormwater
WWW/Stormwater
– WWW/Stormwater
Pink – WWW/Stormwater
Distribution:
Distribution:
Distribution:
Distribution:
Distribution:
Distribution:
Distribution:
Distribution:
White
White
White
White
White
–White
–
White
Office
Office
––Office
Office
Office
––Office
–Office
Yellow
Office
Yellow
Yellow
Yellow
Yellow
–Yellow
Yellow
Applicant
–
Yellow
Applicant
–Applicant
Applicant
––Applicant
–Applicant
Applicant
Pink
Pink
Pink
Pink
–Pink
WWW/Stormwater
Pink
––
Pink
–Pink
WWW/Stormwater
WWW/Stormwater
–
WWW/Stormwater
–
WWW/Stormwater
–WWW/Stormwater
–WWW/Stormwater
WWW/Stormwater
Distribution:
White
––White
Office
Yellow
–––Applicant
Applicant
Pink
WWW/Stormwater
Distribution:
White – Office Yellow – Applicant
Pink – WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE