HomeMy WebLinkAbout4318 WINTERSTONE DR - APPLICATIONS - 2/15/2012Feb 15 2012 5:13RM HP LASERJET FAX
P.1
c�tyof Plannino hem
Collins 281 N. Coll opmeent & TransportationFort Collins,, coA80524 .O. am s80
Phone 970-416-2740 Fax 224.6134
OVER-THE'COUNTER PERMITS ONLY
This applloatlon la to be used to apply for the followln
❑ DemoUtlon.(InlerlorrCin-etruchaw) p Electrical Alteration (�� only
❑ Heating Unit O Lawn -Sprinkler ❑ Mobile Horns replacement (ahaok aU that Lighter
O Air Conditioning
Cl Vantllatlon O Water ��ee) o Gas �Ight•r o 088 log
te9r d Water Unel ❑ replacement
Stove ( be Sewer certified, rove eh mmaka model and
rnahufatxurer),
Corinpl•% all appiloeble Ini'dMation on the eoplicatlon. Incomplete appilcatjr new i�ll net� a`•ecept•d.
Application # o o 1 Date ' / / 11`�/
ForcvAihs rerr any ,
]ob SiteAddregn (regrny��
property Owner Name
Applicant Name
Contractor
1. Address
Address
Lit # Ig ZA i T Address
COntractcr ay of Ft. Collins Sales Tex #
Sskr far nrmrbW&ragcdredOyaV! curd* n
.. n
Value of construction (labor, materials, profit)
$ -7
II City/State ZIP Phone
.. .
City/fit zip Phone
City/state aP Phone
Arc you Payln§ taxes here or by report? M Here O Report
Are you Paying with your trust account? O Yes Gk No
Is this a residential orppm erclal project? Residential 0 Comrnercial
If residential, JS R WSingle Pamlly Detached p Gondo/townhome (single family attached) ❑ Duplex
O Multifamily (aPartrnent) O Garage
If commercial, Is It: D Bank 0 Bar 13 Church O Hotel/Motel C1 Medical office O Office (3 Retail
C3 Restaurant 13 Other (explain)
Is this building "years of ape or more? Dyes O No I/)es,, you rrrayn ed o cvnlxrtt%> /fCA�+serval>ian
If this Is for a denrolltien parrtrit, what year was the building constnuted?
IfPvW to 1075 Peer OR nedd an asbestas a. raerrt to submit wide tfr& VAMkfiWa.
of
*If lawn Bprinklarlbetddiow premnter, must list licensed plumber. If "-time A/C, must "at licensed elecbidan.
Subeonbutow. W Me, company name or C!ry of N Col#m &_enshe 0
alaWdan Plumber MedhankaL_ Roofer
Other
I hereby advhowkfte that I have read this application and state that the above Infonnation Is complete and wr, I agree to
cmrVy with all mqulremants contained herein and city ordinances and state laws regulating bulding mnstructton. I know that a
pert Is not valid until It has been paid and Issued.
Applicent: Print Name; L Let
\ I slpnatureQ&AdLi4i�
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