HomeMy WebLinkAbout1303 Village Park Ct - Applications/Other - 10/01/2012OCT-01-2012(MON) 11:30
P. 001 /001
of
FOr't C4ltinS
Planning, Development&Transportation
281 N. College Ave P.O. sox S80
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 (chock all that apply). Air Conditioning
Demolition (interior ran-structuraq Electrical Alteration (not service change) Gas Lighter Gas Log
Heating Unit Lawn Sprinkler Mobile Ho placemeqRoofing Sewer Line Photo -voltaic
ventilation Water Heater Water line Wood/Pellet Stave i ust be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not a acceptad,
Application # RQD6&-` Date
For oNlee use only .
Is this a residential or commercial > esldenta Commercial
If residential, is It: mJly petached> ondo/townhome (single family attached) Duplex
Multifamily (apartment) Garage
if commercial, is it: Bank ear Church Hotel/Motel Medical of re Office Retail
Restaurant Other (explain)
Is this building 50 years of age or more? Yes No II yet you may peed ro cantactHisronePreservaUon
If this is for a demolition permit, what year was the building constructed?
lfprior to .1975, Mtj will need an asbestos aunt In sub jf With this apV#iVt an.
v—
V lawn sprinkler/baekflow preventer, must list licensed plumber. Ir Flr t•time A/t, must list licensed electriclan.
Subcontractors: List Mt comµvnyname ofC/tyo(Ft Callinsficenz a
plumber _ Mee anlcal
. Rooter Other
I hereby acknowledge that 1 have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained heroin 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 -Signature � DateI CJ�