HomeMy WebLinkAbout4702 PRAIRIE VISTA DR - APPLICATIONS - 5/11/2012City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6l111���1} , Collins Fort Collins, CO 80524
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 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 #��
Forme use only
Incomplete applications will not be accepted.
Date J5 - I ( - C� 0 I
Job Site Address (required) iF02 T�LGi Value of Construction (labor, materials, profit)
70a RQ (� cS 'Din . CO M-26 /a-S-6
Property Owner Name
lGllwLt'—Bru' 470z
ddress
%f/u1i2t�,
1' City tate C01 Zip Phone
Isrh Da. /lus 919 3.�785_
plicant Name
47m
Address
Ponta&
1,1I City/State Zip C�Phone�,�
Dtz Fu2,t Gc S Cp 8 7,89
l�
V,sIA uA)/ o5Z 3
Contractor Lic #
Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or coyy�ercial project? El Residential ❑ Commercial
If residential, is it: LT 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 (explai
Is this building 50 years of age or more? ❑ Yes 93 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 MY need an asbestos assessment to submit with this application.
Description of worko, ftjoct lookm Sup, PNsi, IN gcm i& 6AN L-IblfTS !N C'lif�7"J6
U6 Eiww6 s 5U1V1D
*If lawn sprinkler/backflow 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 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: �j D�
Print NamXIC114AKW.. t� � _ Signature =�kA& Date
5W-20/0,11