HomeMy WebLinkAbout1819 Manchester Dr - Applications/Sprinkler - 04/24/2018FCity of Planning Development & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins CO 80524 Main 970 416 2740 Fax 970 224 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 #
?51 lb-C) UQ-6-011LA
For offil'ce use only
Date `)'%Z I-/ / ,S
Job Site Address (required) Value of Construction (labor materials profit)
Iq 1q MahGhM•lrbyr 4 900
Property Owner Name Address City/State Zip Phone
LD
rYleyy`NIc E l veil ✓1 t &I l N1MVICc Us-)IFY -r-4 CO Ih vas f Co RiG2(o '170 —
Applicant Name Address City/State Zip Phone
K�tZ'gEF1v1GY1�' ?a grVC I?) IF4 (D))14S Cc) 20FSJZ -570- M r�
Contractor /I Address City/State Zip Phone
W► r i le IFo �1- Ca %1 15 CO sat:3 zZ 4310--�P33--0(0 -4
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequvedbyall contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? D<Residential ❑ Commercial
If residential is it Osingie 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 XNo If yes you may need to contact Histonc Preservation
If this is for a demolition permit what year was the building constructed?
Description of work tm"IoA iynir4nll
*If lawn sprinkler/backflow preventer must list licensed plumber if first time A/C must list licensed electrician
Subcontractors List the company na�m_e0or Gty ofF Coll%nPl u-M b i nn SUVI U S
Electrician Plumbe echanical 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 N j,� fled
t
Print Name "rJ'c- Pic'' Signature &ffr�Date
M
d 2/6/2017