HomeMy WebLinkAbout3230 CREEKSTONE DR - APPLICATIONS - 8/25/2014City of Planning, Development & Transportation
a }, R j = 281 N. College Ave P.O. Box 580
I Fort Collins, CO 80524
Phone 970416-2740 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. Incomplete applications will not be accepted_
Application #_ I-41-0aF�0F) Date 912z-be`
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
3230 �.
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Property Owner Name Address
City/State Zip Phone
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(CO -023
Applicant Narpe Address
City/State Zip Phone
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Contractor (? Address
City/State q Zip Phone
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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 accounti, DO es ❑ No
Is this a residential or commercial project? ,13 esidential ❑ Commercial
If residential, is it: 121 ngle 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 ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work '.'S�3 S' -{ �v.`'�l -t n t•9 `'lrvi[=Jy.;;
•-� "s' fa s c .�G.r es
*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 Acense #
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.
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Nnnt Name:(/! ! 1 .riiFa^y r: = Signaturef r`,.�.: Date
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