HomeMy WebLinkAbout1809 GOLDEN WILLOW CT - APPLICATIONS - 9/24/2014Fort 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). E3 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
13 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 #y� `'� 'l>�I 07 Date C(" T-{ - `4
For office use only I _ o
Sob sine Address (required)
Value Construction (laborr materials, profit)
25 SQ �s�
GCA��� vo.�l�
PropertyOwner Name Address
City/State
Zip
Phone T7 O
30-0-U M(IT05 �t C30
t
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Zia -ot?C>
Applicant Name Address City/State
40 AJ*NM'1%19Ai
Zip
Boma
Phone
4)c-GS3 -OSeq
Contractor Address
City/State
Zip
20su
Phone
53 -D.Ss
Contractor City of R. Collins Sales Tax #
&wam„ Isfszdj bYall=
Are you paying with your trust account!
Yes p No
Is this a residential or commercial project? 'A Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamlly (apartment) ❑ Garage
If commercial, t: ❑ l, Is IBank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
` ❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes 'Ij�No If yes, you may need to cnntact H/star/C Pm9ffVatl0n
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbestos assessment to submit w/tlr this application.
Of
*If lawn sprinlder/baddiow preventer, must list licensed plumber. If first timtrIA/C, must list licensed electrician.
Subcontractors: Ust the company name or QYy offt Collins Ikense 0
Electrician plumber Medianical Roofer -RA3 +! Other
I hereby admowledge 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 andstate laws regulating building construction. I know that a
permit is not valid until it has been paid and Issued. /'%
PrintApplicant:e: .J Wf'Va v1 Signature Date " 2� .
Print Name: