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HomeMy WebLinkAbout4107 WAYNESBORO CT - APPLICATIONS - 11/16/2012Dec 17 12 09r57a Francisco Manzano 9705061686 P.1 Ciof ,,.Forty t Collins C(�' Planning, Development & Transportation 281 N. College Ave P.O. Box $80 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVERmTHE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning 0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter O Gas Log ❑ Heating Unit ❑ Lawn Sprinklor 0 Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic O Ventilation G!F,Water Heater 0 Water Line 0 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 # &O— kp!+ ( q onty '1 .ik5 Date // - /S- /-2 11 _ t V -- Job Site Address (required) Value of Construction (labor, materials, proflt) _ Property Owner Name Address City/State Zip Phone ra7U/ Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone SflJ �W l N'C�7, us imolltzretj a GD `l 0 7a Sq0- o-I I' Contractor City of Ft Collins Sales lax # Are you paying taxes here or by report? Here 0 Report Saks tax number is rmui eeayall contracrom Are you paying with your trust account? 0 Yes R No Is this a residential or commercial project? KResidential ❑ Commercial If residential, is it: 0 Single Family Detached 0 Condo/townhome (single family attached) 0 Duplex ❑ Multifamily (apartment) © Garage If commercial, is it: 13 Bank ❑ Bar ❑ Church O Hotel/Motel 0 Medical office 0 Office 0 Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? O Yes 17 No If yes, you may need to Contact Hlstodc Preservation If this is for a demolition permit, what year was the building constructed? If prior to 1975, yw. will need an asbestos asseswxwt to submit widr this application. Description of work *If lawn sprinkler/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or Oty of Fr Collins license # Electrician Plumber Mechanical Roofer 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= Print Name: 10P4C,l5LO MW1AN0 signaturewzaF� - Date