HomeMy WebLinkAbout416 GALAXY WAY - APPLICATIONS - 9/8/2011Sep 08 11 02:65p Echo RRR
303-840-0304 p.3
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524 -�
Phone 970-41&2740, F= 2246134 . .
`y
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply).13 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 0 Photo -voltaic
0 Ventilation O Water Heater O Water Line 0 Woodf%llet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableinformation on the application. Incomplete laications will not be accepted.
Application # `'' W�dJ Date ap D ._
For offm to on4e -I If
lob Site Address (requhwj
Value of Construction (labor, materials, profit)
Property Owner Nart.6. V Address
CO/State Zip
Phone
Applicant Name Address
❑ty/Sta Zp
Phone -i'2L
Contractor Address
City/state Zip
Phone --.5u3
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here port
.Saks ftrnuma-e-a � bran - -- 'vrs
Are you paying with your trust account? ❑ Yes
o
Is this a residential or commercial project? (Residential 0 Commercial
If residential; is it: ..0`5ingle Family Detached 0 Condo/townhome (single family attached) 17 Duplex
0 MuWhrnily(apartment) O Garage
If commercial, e. it 0 Bank ❑ Bar ❑ Church [I Hotel/Motel 0 Medical office O Office D Retail
-❑ Restaurant E3 Other (explain)
is this building 50 years of age or more? O Yes J!IkNo Ifyies, you may need to contact Historic Pr;ese w0bn
If this is for a demollition permit, what year was the building constructed?
Ilpnor to 1975, you w# nmda7 asks assessment to siubmt w bf thcs app✓rcal7om
of work `E-rY -
*If lawn Wrmkler/batldlow preventer, must list 6oensed plumber. If first-time A/C, mast list licensed electridan.
Subcontractase List the company name orOTy of q Collins Ikensie #
Eledman _ - - Plumbs Medwnkal Roofer Other
I hereby acknowledge that..I have read this apprication 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.
AppPrint arrt: %�lYll1V DNS,- e- Print Name: ,. rraRure ' bate