HomeMy WebLinkAbout6127 WESTCHASE RD - APPLICATIONS - 5/30/2013May 31 13 03:53p Rues, LLC 970-619-8074 p.4
-o �t Coll'ans
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 90524
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 14 Water Beater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). Opl
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # I XG 7q Dates I t
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Job Site Address (required)
Value of construction (labor, materials, profit)
Property Owner Name Address
Gty/State Zip
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Applicant Name Address
City/State Zip Phone Q 10 -
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Contractor Address
City/State Zip Phone Cn"'
Contractor City of R. Collins Sales Tax 0
Are you paying taxes here or by report? ❑ Here )2 Report
sales rarnumbertsrequiredbyafcon&-Wtors.
Are you paying with your trust account? R Yes ❑ No
Is this a residential or, pmerahal project? �tesidential ❑ Commercial
If residential, is it: KSingle 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 So years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolifion permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit widr this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orcity oFftCoffins Gcense#
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply Ath 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:
Print Name.[ .Y (7 C)DL LrrV9_'e� Signature i Date
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