HomeMy WebLinkAbout4512 SEAWAY CIR - APPLICATIONS - 9/18/2014�+} Collins
,�` I%(, Planning,Development&Transportation
City ofAve
Fort lli p� 1s �$Z /Ov, �O Fort Col n281 N.ls, CO 80524 P.O. Box 580
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). ❑ 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
Application # 151M577+
Fnr nmr.- r/SP nnly
Incomplete applications will not be accepted.
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
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all
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip3e)3-T1 �7-a/0o
eSS.b.-��S .��e. 3�5/ '�� 0 de & D D
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 account? ❑ Yes ❑ No
ZLO- 9-2470 Cea-+#- 3&y7-2
Is this a residential or commercial project? P'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
❑ Restaurant ❑ Other (explain)
Is this building SO 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.
of work
*If lawn
, must list licensed plumber. `If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # 0/ 0 f0z
Electrician Plumber Mechanical Roofer eo1-zs-1/AJ 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: O/ r ��7
Print Name:vox »n /� Signature Date