HomeMy WebLinkAbout4249 WINTERSTONE DR - APPLICATIONS - 10/6/2011Planning, Development & Transportation
281 N. College Ave P.D. 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler El 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. Incomplete applications will not be accepted,1
Application #_ b /to �4 a Date �o�G
For office use only
Job Site Address (required)
ap-
Value of Co ruction (labor, materials, profit)
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Property Owner NameAddressAddress
City/State Zip
60/tW -
Phone
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Applicant V9me Address
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City/State Zip
Phone
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Contractor Address
City/State Zip
Phone 3b3
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
WHere ❑ Report
sales tax number &rawiredbyal? conhactm.
Are you paying with your trust account?
❑ Yes KNa
Is this a residential or c5mmlercial project? ❑ Residential ❑ Commercial
If residential, is it: 9 Single Family Detached ❑ Cando/townhome (single family attached) Cl 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? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Ke'-f0/.9 w i-t h 4504F d/7 L;�Y4`rh&
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 4
Electrcian 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 with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
penult Is not valid until it has been paid and issued.
Applicant:
PrintName: Signature Date