HomeMy WebLinkAbout4425 STARFLOWER DR - APPLICATIONS - 2/24/2015Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
�O�'°t Collins 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 8' Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). 5
Complete all applicable information on the application. Incomplete applications will not be accepted. \0\
Application # b 1,50 11 t3
For office use only
Date-� -1 r
Job Site Address (required)
Value of Construction (labor, materials, profit)
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660.0(3
Property Owner Name Address
City/State
Zip
Phone
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865 Z S
Applicant Name Address
City/State
Zip
L'2
Phone
Coin Z t 37,z(e ME�s14 vORDe,
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Contractor Address
City/State
Zip
Phone
21Gk_ C 32 MF154 M51RIP
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Contractor City of Ft. Collins Sales Tax #
sales tax number is required by all contractors. Are you paying with your trust account? ❑Yes
0 No
Is this a residential or commercial project? [4esldential ❑ Commercial
If residential, is It: Ingle 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 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.
Description of work j E ft-P., OF F 1 NS -1-0 oC (0M r Roo F" 1 5 `I I
5
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List MecompanynameorCity ofFtColllnslicense #
Electrician Plumber Mechanical Roofer 'TR Qomei + 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.
n /
Applicant -
Print Date
Print Name: �- Signature
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