HomeMy WebLinkAbout4244 STONERIDGE DR - APPLICATIONS - 2/23/2012F rt Collins
Planning, Development 8c TranspoMgtion
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVEWTHE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that applyl. ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
0 Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacament,r"ooMig 0 Sewer Line . ❑ Photo -voltaic
O Ventilation 0 Water Heater 0 Water Line Q Wood/Pellet Stove (must be EPA certified, provide make, mode[ and
manulac turer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application * b om Yy V Date
For oTfte use only
]ob Site d n quarsd)
Value of Construdlon latxu, materials, profit)
Property Owner Name
Address
City to Zip Ph 0 "-
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Applicant Name
Address
City/state Zip Phone
ntracti r
Address
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Contractor City of Ft. Collins 9JAs
Tax #4638
Are you paying taxes here or by report?+ekere ❑ Report
sales rarnumber�naquved oyanct>/,caclnrs
Are you paying with your trust account'es O No
Is this a residentialor co menial project? i0'Residential ❑ Commercial
If residential, is it: oZrSingle Family Detached O Condo/townhome (single family attached) 0 Duplex
0 Multifamily (apartment) 0 Garage
If commercial, is It: O Bank ❑ Bar ❑ Church 17 Hotel/Motd ❑ Medlcal office 0 Office 0 Retail
0 Restaurant : 0 Other (explain)
Is this building 50 years of age or more? fl Yes ElrNo. Yves, you may need to mntact/f�todcP►ese�vaCon
If this is for a demolition permit, what year was the building constructed?
Ifpr/ar to 1-075, Kw wX need an asbestos assessmmtto sudv* with this appllcmbA
Of
*If iawri sprinkler/backfiow preventer, must list licensed plumber. If first-time AfC, must list licensed electrician.
Subcontractors: 1ht Me company name or 01y aFRO l/irrs hhnw 0
Elechirfan Plundw Mechanical Roofer Outer
I hereby admowledge that I have read this application and sbft that the above Information Is complete and oonfect: I agree to
comply with all requirements contained herein and city ordnances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued
Applicant: y� D6 G ,1 SgnaWre Dabe �'2 - Z Print Name: 1 - - -