HomeMy WebLinkAbout4437 WARBLER DR - APPLICATIONS - 8/19/201408/19/2014 11:33 8666038167 MECC PAGE 02/08
cif Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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). ❑ Alr Conditioning
❑ Demolition (interior non-structurpi) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit 13 Lawn Sprinkler 0 Mobile Home replacement Q Rooting ❑ 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. Incomplete applications will t b $$
Application # «D 1!v(q l
rOxce use only
Job Site Address (ragaired)
w r k
Property Owner Name _ Address
Name Address
Contractor' , U _ Address
Contractor City of Ft, tollindSales Tax #
Sales tax number& required byall wnnaero c
no a accepted.
Date 0-14
Value of Construction (labor, materials, profit
� �
City/State Zip Phone
city/state zip Phone
4? 0 Lf88= s
City/State zip . Phone
Are you paying taxes here or by report? +Here ❑ Report
Are you paying with your trust account? El yes C3 No
Is this a residential or commercial project? 'Residential ❑ Commerclal
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
El Multifamily (apartment) 13 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retaji
El Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Ci yes 0 No byes, YOU mayneed to contact Hista*Piese1VRN9n
If this is for a demolition permit, what year was the building constructed?
Ifpdor tO you w///need an asbestos assessment to submit with this application.
Description of work
N
*If lawn sprinkler/backflow preventer,must list licensed plumber. If first-time A/C, must list licensed elearl ' n,
Subcontractors- ListbhgcompanynameorCity ofFtColl/nsl Wse f
Eiectridan_. Plumber. Mechanical RooferOther
I hereby acknowledge that I have read this application and state that the above Information Is complete and correct I agree tb
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: t
Print Name I o-fi Signature Date rr f