HomeMy WebLinkAbout4306 BEAVER CREEK DR - APPLICATIONS - 8/22/2014CI Of Planning, Development & Transportation
Fort Collins For N. College Ave P.O. Box 580
Fort Collins,
CO 80524
Phone 970-41616-27402740 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 ❑ Mobile Home replacement XRoofing ❑ Sewer Line ❑ Photo -voltaic
O 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.
Application #.
For office use only
Date 8' .2-'�- 11
Job Site Address (required)
Value of Construction (labor, materials, profit)
'-130G
Property Owner Name Address
City/State Zip
Phone
kt\1 13067 &bwtr 6-lak R .
6 ao. S Lo 505g4(0
70 -5&9- ;IL I gq
Applicant Name Address
City/State Zip
Phone
Cons % � 101-L
fork (01114-S. CID 9e5a S
30 - 1- 1-5-6
Contractor K - Z3 (o LA Address
City/State Zip
Phone
Con 1-C n 181
t. dirk to .1
3 - 10- 0 5
Li
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors: Are you
paying with your trust account?
❑ Yes ❑ No
Is this a residential ocoprimercial project? oResidential ❑ Commercial
If residential, is it: XSingle 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 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 Ze� -Ro� +0 IIA.t .s a' 56C� j a1 c -S (SL
*If lawn sprinkler/baclflow 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 #
Electrician Plumber Mechanical Roofer f:-X - 3 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:
Print Name: —Ka- 0, r�c%A Signature Date