HomeMy WebLinkAbout918 SANDY COVE LN - APPLICATIONS - 8/14/2014Cityf Planning, Development & Transportation.,
F6o281 N. College Ave P.O. Box 580
rt 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_at apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change)-. thGas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement it Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # fB' l406 35 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
dv &o e Lan Ile $ 225`0
Property Owner Name Address
City/State Zip
Phone
noj?er ¢ 1-
CQ ?oSZS
7-7-7-49
Applicant Name Address
City/State Zip
Phone
aka Oavls sog
t, vw_oln et i-r i8os
Zz) -12-
Contractor Lic # Address
City/State Zip
Phone
Fbl Dave s 1�-7(;-76 36 UvLcolvt 61 Fm (2e oSZ
ZZ)-a(D
Contractor City of. Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
5a/es lax number is required by allcontracrors
Are you paying with your trust account?
Yes ❑ No
Is this a residential or ommercial project? A 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
El. 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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. e2
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: �RIC ��tJ/� g C� Print Name: Signature Date