HomeMy WebLinkAbout1956 Promenade Way - Applications/Sprinkler - 09/11/2019City Of Planning, Development & Transportation
y} 81 N. College Ave P.O. Box 580
�r` Collinslns 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 # 6I I Oq I� Date �1 �'I I A
For office use only
Job Site Address (required)
�CA,
Value of Construction (labor, materials, profit)
(Iti CC y135d- 2 -Y�l-
Property Owner Name Address
City/State Zip
Pho e
(g1ok 31
Applicant Name Address
City/State Zip
Phone
Contractor Address
ko Cc;^- (4vu-c.�i'&-
City/State We l\;k�Zip Cc
LLc 31�t� Ik ' k °�
Phone
9 u� -31
Contractor City of R. Collins Sales Tax #
Sales lax number is required by all contractors
Are you paying taxes here or by report? IZFHere ❑ Report
Are you paying with your trust account? ❑ Yes 2rNo
Is this a residential or commercial project? l5-Residential ❑ Commercial
If residential, is it: 0 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 ONo 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 LAwt-,, Spt�hNevs
*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 ofFt 'Collins license #
Electrician Plumber/� (-w p
to 'I 164, Mechanical 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 regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: e&7 iloLj(ygr5
Print Name: Signature Date
W.
0
r