HomeMy WebLinkAbout6215 WESTCHASE RD - APPLICATIONS - 4/18/2014FCity of Planning, Derelaproent rS Transportation
ort ColUns• 28I N-Collins, 0
Cp 60524 , %
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). D Air Conditioning
17 Demolition (Interionnon-structural) CI ElectnceIAlteration (not service change) 13 Chas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lavin Sprinkler 0 Mobile Home replacement .d Roofing 17 Sewer Line ❑ Photo votale
O Ventilation CI Water Heater ❑ Water Line 17 Wood/Pellet Stove
manufacturer). (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications m t b
Application #B 14 n I D(torj
For otixe ur+e only � --
34b Site Address 'Irma pm4)
Address
Applicant Name v U Address
Contractor Address
Contractor City of Ft. Collinssales Tax #
S�'as lax is�rf>�yry! ctxidaphrr.
W- y
wi no a accepted.
Date IT I N
Value of
CIO/state
s�
City/State
Zip
City/State _ Zip
a lets, profit)
Phone
pL
o ?g7/
Phone
L iM
7
Phone
Are you paying taxes here or by report? 17 Here o Report
Are you paying with your trust account? O Yes d No
Is this a residential or cggmmm®rcial project? . f Residential Cl Commercial
If residential, is it 15ingle Ferrdly, Detached ❑ Condo/bOwnhome (sfngk family attached) 0 Duplex
❑ Multifamily (apartrnerrt) • ❑.,Garege
If commercial, is it; 0 Bank ❑ Bar ❑ Church Q Hatel/Motal O Medical office ❑ Office p Retail
❑ Restaurant ❑ other (explain)
1s this building SD years of age or more? ❑Yes 0 No IFYcs, you may need d, conraetHkAw c Ft anon
If this is for a demolition penmlt, what year was the building cons&ucte:d?
lfpr,ior ra 1975, Yau will nrep'ad aulxs�r �'sessvnaii m suLhm/r w!f!i 1K� appyrat'nn;
Description of work
*If lame sprinkler/badcfiow preventer, must IM licensed plumber. Tf first-blrro q(C, must list licensed electrician,
Subeontra rs: "It dye1XnWnYr,wmeorCityafRa/Atrs!tenseAr
Eleebida Number Mechanicffi 'Q
�� Roofer
I hereby aclaiOwledge that i have read this application and state that the above khformaition Is complete and cone
comply with all requirement: contained herein and city Ordinances and
peeta0e laws regulating bulkirhg construction.
rmlt Is not'Valid until'It has beienn�paid'ard lysued, .
Applicant:
Print Narn,
t. T agree to
I know that a