HomeMy WebLinkAbout4306 STONEY CREEK DR - APPLICATIONS - 5/1/2013Fort Collins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 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 2 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make. model and
manufacturer).
Complete all appli'iccaable Information on the application.
Incomplete applications will not be accepted.
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Application # `.� 0*2`w' .��Ci�Y Date A
For offlae use only yam! O
Sob Site Address (requl�j
Value of Construction (labor, materials, profit)
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2
Properly owner Na a
Address
City/State ZIP
Phone
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Applicant Name
Address
Gty/State Zip
Phone
9intractor
Address
City/State Zip
Phone C 7t7
Contractor City of Ft. Collins
Ais Tax #
Are you paying taxes here or by report?°- ere ❑ Report
Sales tax number 6required byal!
tramrs:
Are you paying with your trust account? 0 Yes
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Is this a residential or commercial project? Ej4kQdential ❑ Commercial
If residential, is it: ClP-'Single 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 ❑ No If yes, you may need to contact Histaricpreserva&an
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of worklll
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time NC, must list licensed electrician.
Subcontractors: List the company name rQy of Ft Collins license 0
Eiectridan Pliunbe 1 Mechanical Roarer 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.
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Applicant. Lignature
Print Name• l ! �/r t
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