HomeMy WebLinkAbout6132 WESTCHASE DR - APPLICATIONS - 10/6/2011City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
xt}}Coitin Fort Collins, CO80524
% _ 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
O Demolition (interior non-struc ural) ❑ Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
O Heating Unit O Lawn Sprinkler O Mobile Home replacement O Roofing ❑ Sewer line. ❑ Photo -voltaic
O Ventilation Water Heater Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer _
Complete all applicable information on the application.
Application # o 119, coo
For office use on
Incomplete applications will not be accepted.
Date _- 119' &'1l
Job Site Address (required)
Value of Construction (labor, materials, profit)
LEA- &4nhavilR.
FL
Lo $05Aq
Property Owner Name
Address
City/State Tip Phone
J+pp�licant
L' ' M
3 - 0030
a
Address
City/State Zip Phone
Contractor
Address
City/State Tip Phone
AAJ ,
w5eal 4941 9 1
Contractor City of Ft. Collins Sales
Tax #
Are you paying taxes here or by report? 0 Here A(Report
Sales tax number a =uired by all corib
loC1
anws.
Are you paying with your trust account? 9 Yes ❑ No
Is this a residential or mmerdal project? esldential ❑ Commercial
If residential, is it; Single Fa ily Debt d O Condo/townhome (single family attached) • O Duplex
Multifamil (apartment) O Garage ,
If commercial, is it: ❑ Bank O Bar ❑ Church ❑ Hotel/Motel 0 Medical office O Office 0 Retail
❑ Restaurar t ❑ Other (explain)
Is this building 50 years of age r more? 0 Yes 0 No If yes, you may need to contact Historic Preservation
If this is for a demolition permi , what year was the building constructed?
If prior to 1975, you will need an sbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow prevent r, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the compan name or City of Ft Collins license P`
Electrician Plumb e` _ Mechanical Roofer Other
I hereby acknowledge that 1 have rE ad 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: h �(� I 6rin -
Print Name. Signatur Date _ t r
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