HomeMy WebLinkAbout909 Chippewa Ct - Applications/Addition or Alteration - 04/20/2015City f Planning, Development & Transportation
Fy o281 N. College Ave P.O. Box 580
lirt Collins 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 ❑ 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. Incomplete applications will not be accepted.
Application # a 15D 2-1 (9 Date q-,20 - 2015
Mr office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
qoq
T1. 1 r'S
!B a'73'Z 00
,
Property Owner Name
Address
City/State
Zip
Phone
�on 4 Steer \ b
90 GI.', ��
C� F�. CAJ,
CO 6
970-d1 y- `o t 6
Applicant Name
Address
City/State
Zip
Phone
19(4-�. Sck4eg"r
` 0-zox 330
14?or4e Co
35
'ib-66G-997
Contractor
Address
City/State
Zip
Phone
ArmAft A A(tw qn
aA 330
1Aor)e. C6
6cQ,5
99v-�P -)))3
Contractor City of Ft. Collins Sales
Tax #
Are you paying taxes here or by report?
JI Here ❑ Report
Sales tax number is required by allconbactors
Are you paying with your trust account?
❑ Yes k No
Is this a residential or commercial project? N Residential ❑ Commercial
If residential, is it: A 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? El
Is 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/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors. List the company name ortCity ofFtCollins license
#
EledridanoSCn LKAhriL Plumber '0 Mechanical _ lWrt Roofer Ph 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, r(�/(� c\
Print Name: �KQ\% I. JLYiM,1GIE( Signature
Date 00 -A15