HomeMy WebLinkAbout4700 WESTBURY DR - APPLICATIONS - 8/11/2014To: Page 3 of 7 2014-08-11 16:49:17 (GMT)
18663247566 From: Julian Rector
Planning, Development &
of(
Transportation
rCii'ty N. College Ave P.O.
FvA t '\ ollins Fort Collins, CO 80524
Collins
580
■"�+r. Phone 970-416-2740 Fax 2
4-6134
`w
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that appl
). ❑ Air Conditioning
Ll Demolition (interior non-structural) 13 Electrical Alteration (not sery a change) L! Gas Llg
ter [7 Gas Log
• Heating Unit t7 Lawn Sprinkler 0 Mobile Home replacement ,Roofing 0 Sewer Line
t3 Photo voltaic
13 Ventilation 0 Water Heater ❑ Water Line i3 Wood/Pellet Stove must be EPA certified, p
-ovide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will no
be accepted.
Application # Lq:o -2�0 Date
l
For of'lce use only
Sob Site Address 6 uired) Value of Construction (!a
, materials, profit)
) ,fir•' it t'
Property Owner Name Address city/state Zip .
Phone
�- e} f didh
..
Applicant Name Address Ci /State Zip
Phone f'
Ky
Contractor Address City/state Zip
Phone ` 5
t.. .t
p` ,:.:i'.�F.. ' r'^�, ' f'„' �', t. v a {'f' Rr »'fi i5 , r �
.. 9'r Ft • f ' ��� �'
-
Contractor City f Ft. Collins,6les Tax # Are you paying taxes here or by re
? 0 Here deport
sores taxnum eer,srcggairemayauamtrvrrors. Are you paying with your trust accou
t? O Yes C91bo
Is this a residential or, c9mmercial project? j3•Residentlal O Commercial
If residential, is it: 'i ngie Family Detached E3 Condo/townhome (single family attached)
❑ Duplex
0 Multifamily (apartment) 0 Garage
If commercial, is it: E3 Bank 13 Bar Q Church (3 Hotel/Motel i3 Medical office E Office I
I Retail
13 Restaurant 13 Other (explain)
Is this building 50 years of age or more? ❑ Yes , 2"o If yes, you may need to contact HIstowc
Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you W11 need an asbestos assessment to submit with this application.
Description of work ,Y'-e C �" s
-
t"
�.
*If lawn s 'nkier/bWow preventer, must list licensed plumber. If first-time A/c, must list licensed eletriclan.
Subcontractors: Last tlfe company name or t;lty 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 ind correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building con kruction: I know than e
permit is not valid until It has been paid and Issued.
ii
Prplrpit llama; s i irr � =.`signature 1-- _ Da