HomeMy WebLinkAbout748 Blue Mountain Dr - Applications/Addition or Alteration - 03/31/2008City of fort Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 80522
Phone 970-221-6760 Fax 970-224-6134
OVER-THE-COUNTER PERMITS ONLY
City of Fort Collins'
Use this application to apply for a permit for any of the following: (check all that apply) ❑ air conditioning, ❑ demolition
(interior non-structural), ❑ electrical alteration (not service change), ❑ gas lighter, ❑ gas line, ❑ gas log, ❑ heating unit,
❑ lawn sprinkler, ❑ mobile home replacement, ❑ roofing, ❑ sewer line, ❑ ventilation, ❑ water heater, ❑ water line,
❑ wood stove (*provide model name & number).
Complete all areas of the applications that are applicable to your permit request - Incomplete applications will not be
accepted. An over-the-counter•permit will only be valid when it has been paid -in -full and issued.
Application # Lid
Date, / C/
jS
(for office unse onlly)
Property Owner Name
Address z�P Phonej7c� �I-di�
Applicant Name
Address c;2G z i 5 J Phone y�) -(f O y
S 1� JcN ! ,/�/� L2
0%Sr�vl-- (fit.( (% aVj '�
Contractor Name City Lic #
Address Phone I(7v —,/_ol�u-
�r
Contractor City of Ft. Collins sales tax #
Pay taxes here? ❑ Yes ❑ No
Job Site Address
Value of Construction (labor, material, profit)
$
7-9
Is this a residential project? ❑ Yes
❑ No
If residential is it: ,,�" Single family detached
❑ Condo/Townhome (single family attached)) ❑ Duplex
❑ Multifamily (apartment)
❑ Garage
Is this a commercial project? ❑ Yes
bS No
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?
If may need to historic
❑ Yes ;d; No
yes, you get preservation approval prior to permit issuance
Description of Work t�2' e � I E_
� r-
**If lawn sprinkler/backnow preventer installation, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: (list the contractor company name or license #)
Electrical Mechanical
Plumbing Roofing Other
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements contained herein and city ordinances and state laws regulating building construction.
Applicant:
Print Named �=� rl�2 Signature C%� r� Date
Im
y
ME
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