HomeMy WebLinkAbout2912 Radcliff Cir - Applications/Other - 01/05/2018City o f Planning, Development & Transportation
Fort Collins For College Ave P.O. Box SSO
Fort Collins, CO 80524
Phone 970-416-27-10 Fax 224-6131
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the followingpermits only
p y (check all that apply). Air�_andit' ng
Wi
Demolition (interior non-structural) ' Electrical Alteration (not service chance) Gas Lighter C asI gni,l
Heating Unit Lawn Sprinkler Mobile Homej3cenient _ Roofing Sewer Line Pho•,o-Voltaic-
Ventilation Water Healer Nater Line Wood/Pellet Stove
manufacturer). _ ..__` st be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete application "II
Application #
For office ease only
Job Site Address (required)
lSCCi IIn i
Property Owner Name
l6ICt lei 1ti 1
Applicant Name
Address
I
Address
s wr not be accepted.
Date _ 1 I S I Icb
Value of Construction (labor, materials, profit)
Z- I <� %,r 3 C -C) 7
City/State Zip
-
City/State Zip
Contractor Address City/State Zip
yVG�l�rLpi t'"Ict1'�dsCC t=L
Contractor City of Ft. Collins Sales Tax Are you paying taxes here or by report?
Wires tax number is requiredby,31CMrracrors. Are you paying with your trust account?
"1 I EJ.
Is this a residential or
if residential, is it:
Commercial
h
Phone
r'r, ,y
Phone
Phone
11-1 4c:)C- c, X
Here e o,rt
Yes No
n ome (single family attached) Duplex
htuluraiY IV7 partment) 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 /< �;o If ye , you may need to comae! Historic Pre5e. t•aGOn
I) this is for a demolition permit, what year was the building constructed?
ifprior tc,1975, you rviN reed an asbestos assessment <'o submit v: ith this app4 anon. �—
Description of vicirk
tt:e r
if lawn sprinkler/backflo:v preventer, must list 6can3ed plymbrr. If First unne 4 m r licensed 1, ust list eiectr .,n.
Subcontractors: Cisr the Cem;:ary name ar G; of R Coi./.ns license x
iJecrici=n_A____ Piu^,ber
-- -'-- '�dnigll-.`____-._ "oorer Other
t hereby acknavledge that I have read this application and state that the above information is coin 1=•ia and correct. I agree to
comply wiG, 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:\ &1-1' ---'4'1Q l� Signature � 1 / `�lu�
—Date _JL.-/ lr�