HomeMy WebLinkAbout3230 WETTERHORN DR - APPLICATIONS - 9/12/2014Planning, Development ♦1'c Transportation
City of 281 N. College Ave P.O. Box 580
FY6rt Collins Fort Collins, Co80524
Phone 970-416-27402740 Fax 2246134
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 ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # T®J� V
For ofte use only
Incomplete applications will not be accepted.
Date
Sob Site Address (required)
Value ofConstruction (labor, materials, prom)
Property Owner Name Address City/State Zip Phone
Applicant Name Address
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City/State Zip Phone
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Contractor
City/State Zip Phone
�/ 4 LAddress
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? '-Here ❑ Report
Sales tax number isrequired bya#canbacMm
Are you paying with your trust account? ❑ Yes ❑ No
001203.
Is this a residential or commercial project? ILResidential ❑ 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 50 years of age or more? ❑ Yes ANo if yes, yvu mayneed to cvntactHistonc Preservation
If this is for a demolition permit, what year was the building Constructed?
ifpnorto 1975, you MY need an asbestos assessment to submit m i fts applicab'on.
of wo
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*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the comp3nynameorOfyofFtCol/inslicense # Electrician PlumberMechanical Roofer S L ` /
f der
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:
Print Name: i �` ram` k' signature