HomeMy WebLinkAbout4351 GEMSTONE LN - APPLICATIONS - 1/16/2015F.. Collins
Planning, Development W •Transpefttion
281 N. Cal!ege Ave P.O. Box 580
Fort Collins. CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER I
This application Is to be Used to apply for the follow.insd permits only (check all that apply). 0 Air Conditioning
L1 Demolition (interior non-structural) 0 Electrical Alteration (not service change) CI Gas Lighter r Gas Lod
ll. Heating Emit 0 Lawn Sprinkler 0 Mobile Home replacement .0 Rool ng 0 Sewer Line 0 Photo -voltaic
❑ Ventilation I%water Heater ❑'Olater Line' ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).`
Complete all applicable infonnattiion on the application.
Application � m ( S
=or of
t%ce u_a> only
Incomplete applications will not be accepted.
i 3ob Site Address ;requitetO __.-\----------...A-.
Value of Construction (labor. materials, profit) v 1
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Property Owner blame Address
Cityi/State Zip
Phone
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ApplicantMane lame Address
city/state Zip
Phone
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Contractor ` Address
City/StateZip
?hone
0
............
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Contractor City of Ft. Collins Sales Tax #
_
Are you paying taxes here or by report?
.,r7l-iere 0 P.epclt
Sales tax number is n-cRi ed by all contwamn
Are you paying with your trust account?
;.Etles 0 No
Is this a residential or commercial project? Z-Residential ❑ Commercial
If residential, is it: j:)-SinQIe Family Detached 0 Condo/townhome (single family attached) 0 Duplex
0 Multifamily (apartment) 0 Garage
'If commercial, is it: 0 Bank 0 Bar ❑ Church 0 Hotel/Motel 0 lkledic it office 0 Offic:e 0 Retail
'0 Restaurant 0 Other (explain;) .....
Is this build'liEg 50 yai lri of ago -or mom? Q YW 0 No If yesf ,You ro;3y need to Cot7ta i HI'S ctic FmsFtvd.+fOn
i If this is for a demolition permit, what year was the building constructed? .—_------_-_
LFprier to ,t9�5, you rv,:7re'�c7 =an as<S�szas.:.ssessme.,t'[o svbmir rviz%s this aop::cvtior..
Description of viork
*If Eiivin sprinkler; backrlow preventer, must list licensed plumber. if first-time A/C, must- list IlLensed electrician.
Subcontxactars: ! ist the company name or CRy of R Collins license :F
Electrician..--------- Plumb2} ' =` f. ..... Mechahical----------- R°°;`er _.. Other
I heret;y acknowledge that I have read this application and state that the abave informabon is. coinplete and correct. I agree to
comply with all requirements contained Herein and city ordinances and state lauds. reguiating buildling rcnsh uction. I know that a
permit is not valid until it has 19 60 paid and iri5ued.
Applicant.
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