HomeMy WebLinkAbout2721 Amber Waves Ln - Applications/Addition or Alteration - 02/24/2020City of Planning, Development &Transportation
■— _ _ _ t or N. College Ave P.O. Box 580
^��(``�"�"- Collins.7 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 pennits 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 applicabtet
e information on the application. Incomplete applications will not be accepted.
Application # 0 U SS�
For office use only
Date "t 4 -I'CIL6
lob Site Address (required)
Valu of Constru ion (labor, materials, profit)
Property Owner Name Address
City/State ip
Phone,/
Sl^1,41 u�C�%✓G`tJ UA
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9
A plicant Name Address
City/State Zip
Phone
A( C
r - CX Z-
Lza-
Contractor Address
Ci /State Zip
Phone
01- J,
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contactors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? 5-Aesidential ❑ 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 (e:YebLilding
)
Is this building 50 years of age or more? ❑ Yeso If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was constructed?
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 or City of Ft Collins license #
Electrician 1J� Plumber'EP 5 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: Z /, /�_6
Print Name:,l 1 K- ��iQl�i���Signature Date