HomeMy WebLinkAbout1133 INDIAN SUMMER CT - APPLICATIONS - 6/17/2013JUN-19-2013 07:33 From:Allen Service 970 4e4 444e To:92246134 Pase:8/9
Fort Collins
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). 0 Air Conditioning
❑ Oemolition (interior non-structural) 13 Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
I'Pealing UnibC Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation Nater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manu(acturer).'
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 3o3v 3/ Date �`/7 /3
For oKCe use Only'
JUD �ILe R(loress freduired)
-1133 / . • ,/
4Pr oertv DWner Namq^
/K-V 6fµt'
A plicant Name
Contractor
erg F
Address
SAS.
Value of Construction (labor, materials, profit)
�J.Z67� - l V1,6-od
Phone
y!� Phone
P. G=/ r
Address City/state Zip Phone
Del f r `tOSdi �FS�'- i/g i
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or
Sd/ei Id.-nrunber rs required Oy al/canrta[rors by Report. O Here Report
Ave you paying with your trust account?)Q Yes ❑ No
City/state Do
Gty/State ZIP
Is this a residential or ypmmerdal project? �piP lc, n4al ❑ Commerrjat
If residential, is I. -A. Single Family be Condo/townhome (single family attached) ❑ Duplex
l 0 Multifamily (apartment) 0 Garage r
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical omce ❑ Office 0 Retail
❑ Restaurant, 0Other(Atheb
Is this building 50 years of age or more) 0 Yeso Jfyrs, you may need to contact HismrK PrCSCr✓a17017
If this is for a demolition permit, what year wasliding constructed?
1/pr1or to 197S, you wits 17e-dan asbestos assessment to submit wltlr t/yif appficaoon,
Description
VE
aN mxrer/oacxnow preventer, must list licensed plumber. If First-time A/C, must list licensed electrician.
bcontrators: list the company name drCityofe,Col/insr
[,Su
lectrician Plumber. Medlanical Roofer
Other
r ucrcuy acxnowieoge 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 dry 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.��eF�,l
Signatur Date-�� /•