HomeMy WebLinkAbout1804 Crestmore Pl - Applications/Sprinkler - 06/27/2017CCltyof Planning, Development, & Transportation Services
"OI"t ��i1$ Community Development & Neighborhood Services
281 North college Avenue
Fort Collins, CO 80524 Main 970AI62740 Fax 970224 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 (intenor non-structural) ❑ Electncal Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Une ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Une ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable informa:790
a application.
Application #I
For offl a we ony
Incomplete applications will not be accepted.
Date & - 7-7 - 1-7
lob Site Address (required) Value of Constru4iton (la r,, materials, profit)
I 5,41
Property Owner Nam Address City/StateZip Phone
U)As 5 70- YL
Applicant Name Address State Zip Phone
3 Z. Co - ao
Contractor Address City/State Zip Phone
(alkill RQ01
con cbor City of FL coirAs Sales Tax # Are you paying Uxes here or by report? ❑ Here ❑ Report
sway axnumbwisfequliedbyal/cnnvaaom Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or merdal propd7 Reedenbal ❑ Commercial
If residential, Is ft: Single Family Detach ❑ Condo/trnmhome (single family attached) ❑ Duplex
f(] Mufiffamlly (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this budding s0 years of age or morel O Yes O No If yes, ymu may need to contact Hu one Preszw bon
If this Is for a demolition permit, what year was the building constructed?
Desmption of work f i <
*If lawn sprinlder/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List Me company name or aW of R co/fins /sense #
Bect idarc Plumbs MedwOm Roofer 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 regulabng budding construcbon. I know that a
permit Is not valid until it has been paid and issued.
Applicant:
Print Name CG ( Signature Date
M
fedslon dace Mann