HomeMy WebLinkAbout4348 WINTERSTONE DR - APPLICATIONS - 5/4/2012G' C f `L Vj , lC) , 2p i2 Planning, Development & Transportation
�rt CO■ ■ in� C�u1N. College Ave P.O. Box 580
�.�d left �knol� Fort
t Collins, CO 80524
/'^'�� �Q ir►�j1 % r 4/ Phone 970-416-2740 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 ❑ Roofing ❑ Sewer Lane ❑ 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. Incomplete applications will not be ac pied.
Application # I ZO 2�oD3 Date L ' 3�
For office use only
4 ob S
ite (requtred) Value of Construction (labor, materials, profit)
1( $ Z5/000 /5
L- — - - -
Property Owner Name I Address
City/State Zip
Phone
1Pj.c�ow. Sov(oc L(5" (,J". evsi�n� Dr. P.60"t^s 60-5Z
Applicant Name Address
City/ tate Zip
PhoneS��' 1
Contractor Uc # Addrn
City/State Zip
Phone
Contractor City of Ft ns Sales Tax #
Are you paying taxes here or by report ❑Report
sales tax number is required by all mnbactors.
,
Are you paying with your trust account. ❑ Yes
��No
Is this a residential or commercial projectsideMial ❑ Commercial
if residential, Is it: le Family De ❑ 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? 17 Yes - ❑ No if yes, you may need to contact Htstorlc Preservation
If this is for a demolition permit, what year was the building constructed?
ifprlor to 1975, you will need an asbestos assessment to submit w/th thts appl/cadon.
Description of
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Colflns license' C`
Electrician Plumber Mechanical Roofer n cJ P__ 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: 1 ,
Print Name: ,TAK r�uw� Signature
Date
4
T'd S006L92OL6 OWI 9WId00d S03ii WdTb:Z 2TO2 b0 SeW