HomeMy WebLinkAbout414 RIDDLE DR - APPLICATIONS - 9/18/2013City. of
Collin
E-
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # 1�50q (0(_/
For ofte use only
Incomplete applications will not be accepted.
Date
]ob Site Address (requi ) Value of Construction (labor, materials, profit)
Property Owner Name
Address
/y
City/State .
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Zip Phone
�. all
Applicant Name
Address
City/State
Zip
Phone
Contractor Uc #
LaWr✓ A4,e1 rv6
Address
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City/State
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Zip
A' co F�,07
Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here
j�Report
Sales fax number& mqulred by a# contractom
3 Vl Y
7 Are you paying with your trust account? ❑ Yes
�No
Is this a residential or mmercial project? Residential ❑ Commercial
If residential, is It: Single Family Deta ❑ 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? EI Yes No Ifyes, you may need to contact Hkgonc preservation
If this is for a demolition permit, what year was the b ilding constructed?
rfprior to 1975, you will need an asbestos assessment to submit wid► this applicaffon.
Description of work
W
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: fist the company naffle or Oty of �t Col[liKns//�icerxse #
Oechidan PiumtrerfiT ulaf ked�aniol Roofer other
1,
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.
Applicant:
Print Name: ��� - / r'� Signature � ate