HomeMy WebLinkAbout2307 Montadale Ct - Applications/Addition or Alteration - 05/02/2008City of fort Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 80522
Phone 970-221-6760 Fax 970-224-6134
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Ci#y of Fort Collins
OVER=THEnCOUNTER PERMITS ONLY
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 # )b 0'R 0 ( 5 7
(for office unse only) .
Date
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Property Owner Name Address z /p
Phone
l�on4/r® K Se11:1tL- WO!S 17
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Applicant Name Address Zip
Phone
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Contractor Name City Uc # Address
Phone
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Contractor City of Ft. Collins sales tax # Pay taxes here? ❑ Yes
❑ No
Job Site Address
Value of Construction (labor, material, profit)
2307 jVq..&,�Ie- I
$ (oyc:17
Is this a residential project? lK Yes ❑ No
If residential is it: 0 Single family detached ❑ Condo/Townhome (single family attached)) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Is this a commercial project? ❑ Yes 0 No
If commercial is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotei/Motel ❑ Medical Office
❑ Office .❑ Retail
❑ Restaurant ❑ Other(explain)
Is this building 50 years of age or more? ❑ Yes K No
If yes, you may need to get historic preservation approval prior to permit issuance.
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Description of Work TK C / so/A.r ko+ woftr kP%E
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**If lawn sprinkler/backflow 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 Name I�n S c{t Signature �-r?� Date
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