HomeMy WebLinkAbout2625 Brookwood Dr - Applications/Addition or Alteration - 07/06/2017Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 # Date
For ofte use only
Job (required)
Value of Construction (labor, materials, profit)
/Site cAddress
zb 2 J /oa cC,✓Ga
Property Owner Name Address
City/State Zip
Phone
SC GZ_ ie tSoX
771qa ��. ��l%f.� 0 ELL /2-So
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
C VA' gotA44 or P. Cf pa
fax Z7/06q P1 l0(1140
zla-563
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
OrHere ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes No
Is this a residential or commercial project? gResidentjal ❑ Commercial
If residential, is it: 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 (explain)
Is this building 50 years of age or more? ❑ Yes 9No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
, 14 rlf/G`A. ®CIN 'Z�r
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician V r(6Ct 7 i Plumber NO tf° Mechanical A ( /'OAS Roofer N�ii 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:
Print Name: N/�r �SL^�%CITa'L Signature �_ Date G