HomeMy WebLinkAbout4307 BEAVER CREEK DR - APPLICATIONS - 7/11/2014City of Planning, Development & Transportation
F _ __t Collins 81 N. College Ave P.O. Box 580
�-`�`'�"i ` 1 1 Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY ► z� •��•
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�er%ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit El Lawn Sprinkler [I Mobile Home replacement §7y Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Sto a (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 12-)14-DF�1 11.,?
For ofl9ce use only
Date/may
Sob Site Address (required)
p Value of Construction (labor, materials, profit)
lu�Lp, a a�
Property Owner Nanle
5 R20
Address
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Phone
KDty �0>I 7' 3
Applicant Name
Ci rm i�
Address
(P�11 u7_ %is
City/State Zip Phone
S C fbo(a3 q70 -ZZ f 77s
Contract o
Address
City/Stat Zip Phone 9;0
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Contractor/City of Ft. Collins Sales T x #
Are you paying taxes h re or by report? 1�! Here ❑ Report
Sales bx number srep�u� all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or (Immercial project? )<Residential ❑ Commercial
If residential, is it: EKSIngle Family Detached ❑ Condo/townhome (single family attached) ❑ 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 l!q No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpdor to 1975, you wlll need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacidiow preventer, must list licensed plumber. If first-time NC, must list
Subcontractors: List the company name orCity offtCollins license#
Electrician Plumber Mechanical Roofer r-+� / 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: 'A
Print Name:
Date —7 4,
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