HomeMy WebLinkAbout912 FOSSIL CREEK DR - APPLICATIONS - 4/30/2013APR-30-2013(TUE) 16:08
P. 001 /001
CPR
City of
Fort Cotir�s
Planning, Development & Transportation
281 N. College Ave P.O. Box Sao
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 permits only (Check all that apply). Air oning
Demolitlon (interior non-structural) Electrical Alteration (not service change) Gas lighter Gas log
Heating Unit lawn Sprinkler Mobile Home replacement Roofing Sewer line Photo-vo to c
Venttlatlon Water Heater Water line WcodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application I 3c) 11.12 Data -10Ae V-LL, 7A( 3
Air ofriea us.- only
Is this a residential or com
If residential, is it- Single Famlly
Commercial
nhome (Single family attached) Duplex
murtnarmry Capartment) Garage
If commercial, is It: Bank Bar Church Hotel/Motel Medical orrice Office Retail
Restaurant other (explain
Is this building so years of age or more? Yes No IPy� you may need to Wn0ct H/stork Pri=rvaribn
IF this Is fora demolition permit, what year was the ui ding constructed?
lfprior CO .197S, you wit/ need an asbrstos assessment to submit with this appllcapon.
Description of work
"If lawn sprinkler/backflow prouenter, must list licensed plumber. If Mrst•time A/C, must list licensed electrician.
Subcontractors: CISr nc� rnmµYny Hume ar pry afhT Caginslitcnse t
peRNaian�� Plumber mechnnleal Roofer_ ether
I hereby acknovdedge that I'have read thls appllcadon and state that the above Inrormadon Is complete and correct. I agree to
comply with all requirements contained hereln and city ordinances and state laws regulating building construction. x know that a
Permit is net valid until it has been paid and issued.
Applicant: /� _ Zli - 1 ,_
Print Name; �`rVy`� Signature
Dote _