HomeMy WebLinkAbout4700 WESTBURY DR - APPLICATIONS - 9/17/2013rFCity Of Planning, Development & Transportation
ort Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to ER— THE'COUNTER permitsused to apply for the f011owing PERMITS ONLY
❑ Demolition (interior non-structurap ❑ Electrical Alteration (not service hang) al❑ Gas Lighter 0 Gas Log
apply). ❑Air Conditioning
13 Heating Unit ❑ Lawn Sprinkler d Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 Water Heater ❑ Water Line ❑ Wood/pellet Stove (must be EPA certified, provide make, model and
manufacturer).
C
omplete all applicable. information On the application.
Application #
For othco use only
Job Site Address (required)
Property Owner Name Address
1-700 LVk
Applicant Name Address
Contractor Address
Incomplete applications will not be accepted_
Date $ f/ 1�-� q`
Value of Construction (labor, materlals, profit)
'$ 13, 2
city/State Zip
Phone
City/State Zip Phone
City/Stab:: Zip Phone
Contractor City of Ft, Collins Sales Tax # U1174
salestaynrevuhedbyen
umberIs Are you paying taxes here or by report? 4 ,I Here Report
m"�`7Drs Are you paying with your trust account?
1. )3'Yes ❑ No
Is this a residential or commercial project? Residential ❑Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single Tamil
tj Multifamily (apartment) ❑ Garage ( g y attached) [I Duplex
If commercial, is !t: 0 Bank ❑ ear ❑ Church 11 Hotel/Motel ❑ Medical office Ca Office ❑Retail
O Restaurant ❑ Other (explain)
Is this building 50 years of age or more? [i yes �No Ffyes, }mu may tp con
If this Is for a demolition permtit, what year waconstructed?
s the building tactH/stotYc Pmseruation
Ifpryor to 1975, you w/ll need an asb
estos assessment to submlt with tb/s application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If. first-time A/C, must I
Subcontractors: Ust the cnmparry name or CIY of R Collins license ,# lst licensed electrician.
ElectricianQ]�y�'u Plumber. Mechanical RoAr
—�_ Other
I hereby acknowledge that I have read this application and state that the above In
comply with all requirements contained herein and city ordinances and state Paws regulating
Is complete and correct, i agree to
permit is not valid until it has been paid and issued, building construction, Ic know that a
Applicant:
Print Name: Signature_
Data