HomeMy WebLinkAbout966 WAGONWHEEL DR - APPLICATIONS - 10/28/2011City. of Planning, Development & Transportation
j' 281 N. College Ave P.O. Box 580
/YFOr` Collins 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 se 'ce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet St a (must be EPA certified, provide make, model and
manufacturer).
Complete all applica le information on the application. Incomplete applications will not be accepted.
Application # t lucils I Date
For office use only I I I
Job -Site Address
Owner Name, Address
Name / Address
/ Lic # Address
Contractor City of Ft. Collins Sales Tax #
Sales tar number is required by all contactors
Value of Construction (labor, materials, profit)
City/State Zip Phone
Zip
City/State
Are you paying taxes here or by report?
Are you paying with your trust account. ❑
-'Y Q
Phone 7-2e2-
Phone
Is this a residential or mercial project? Residential ❑ Commercial
If residential; is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ ultifamily(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 w/ll need an asbestos assessment to submit wib9 this application.
Description of work
Report
^
0
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List bye company name or csfy of Ft Collins license #
Elect idan 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
permit is not valid until it has been paid and issued
Applicant: /� �I _,
Print Name:•-ignature' %lbate