HomeMy WebLinkAbout4740 PLAYER DR - APPLICATIONS - 9/23/2014CityOf Planning, Development & Transportation
} 81 N. College Ave P.O. Box 580
Port Collinslns 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). ❑ 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 # 14t7R—I (04- Date I&TII4
For office use only
Job Site Address (required)
47Yo player dr
Value of Construction (labor, materials, profit)
3200_ - 32 -7
Property Owner Name Address
6 rdovA Vov-u-se 4M Pla e•
City/State Zip
D. t Tc 8052.s
Phone
22(r-Iz` _5
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
Are you paying taxes here or by report?
Are you paying with your trust account?
❑ Here ❑ Report
N)Ies ❑ No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: >0 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 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed 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.
Description of work f e&. - - off e x i s 4 1 ..g roo (Z „q _ A PP (y fi 3 0
ikpDly Ka. Lowtce,, Lego,c„ sL.,..gles
V �
*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 license # n
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.
Applicant: d 6
Print Name: OuG BP2. Signaturey Date 9 23