HomeMy WebLinkAbout4436 WATERLEAF CT - APPLICATIONS - 7/25/2014City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FOrt Cottin5 Fort Collins; CO 80524
�- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY it I2�
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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # E21LAV j I I
For o>i,ce use only
Job Site Address (required)
el 116 .w A ¢A I -P r1 / (� O. R
Property Owner Name Address
L o c k LJv'AJ 1123,
Applicant Name Address
Jet Q, .&iA 22 y9 PecW
Contractor Address
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all mnbacfois.
WA
Incomplete applications will not be accepted.
Date
Value of Construction (labor, materials, profit)
City/State Zip Phone
W Pnt)121 Fri//..�/_ �-�� 97.E
City/State
R C)'0,oa
City/State
Zip
tse
Zip
Phone
:�'r97yyo,
Phone
w y7-faxd, J�N &1/,lb
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? (& Residential ❑ Commercial
If residential, is it: );§ Single 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 o 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 applipUon.
Description of work _�e e M o u e= . Z o
u VAuJ
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Suboorrtractors: List the company name or City of Ft Collins license #
Electrician 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: ;7
Print Nam: E' eT� RdA Signature pate J u& 21 2v1(/