HomeMy WebLinkAbout4454 VISTA DR - APPLICATIONS - 3/21/2013MAR-15-2013 15:27 From:Allen Service 970 484 4448 To:92246134 Pa9e:10�13
City of
Fort Cottins
Planning, Development & Transportation
281 N. Colie Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER—THE-COUNTER E'R PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). LI Air Conditioning
O Demolition (interior non-struoturah ❑ Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log
a t-f-leating Unil 0 Lawn Sprinkl O Mobile Home replacement O Roofing ❑ Sewer tine O Photo -voltaic
0 Ventilation Q Nater Heater Water Line 17 Woodlpellet Stove (must be EPA certified, provide make, model and
manufacturer)' ' 7�
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # t 1301 as rR!'/u� � �3
Date 3 ^�
For or Use Only 5 • /')O-..--
Job Site Address (Jeam Value of Construction (labor, materials, profit)
�l`l5y C GD d 60, DQ-
Prooerty Owner Nam9^ Address City/state 2to Phone
—.Aicu gag-601 -1
A plicant Name Address CIWState Zip Phone
Contractor Address City/state Zip , Phone �-
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XRPport
;ales tax number is rcyurr,-d by ad am&aL%ays Are you paying with your trust account?)K Yes Cl No
Is this.) residential or mmercial project? `.>��ential ❑ Commercial
If residential, is Single Family De ❑ Condo/townhome (single family attached) ❑ Dupiex
Multifamily (apartment) ❑ Garage
if commercial, is it: ❑ Bank 0 Bar 0 Church 0 Hotel/Motel 17 Medical office - ❑ Office ❑ Retail
❑ Restaurant 0 Other ( In)
Is this building SO years of age or more? O Yes jlo4c IfYES you rrrayneed to CavrtacrHistoric Preservation
if this is for a demolition permit, what year was the &jlldlng constructed?
O prior to I975 you will nnr�an asbestos assessment to sub►mr with tlytq application.
Description of vy+ork*o
Em
.. ,o..,, ayimKrer/oacknow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors! list the company n vme or City of R Colyns kcense 0
6ectrippn Plumber McGhanxal fiCOrer Other
1 hereby acknowledge that I have read this application and state that the above Information Is Complete and correct. I agree to T
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: �^ �/J-,Print Name: ��i�! l� 111 signatur Date ���