HomeMy WebLinkAbout4213 STONERIDGE DR - APPLICATIONS - 3/18/2015City of Planning, Development & Transportation
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!� 281 N. College Ave P.O. Sox 580
Colti !S 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 sFZ;7'O
ge) ❑ Gas Ughter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certfied, provide make, model and
manufacdtuer)..
Complete all applicable
//information on the application. Incomplete applications will not'be accepted. ` O`
Application # Date �!:il I I l,s a
Foro>i5ce im on/y t—
lob Site Address Cre9u/redI
Value of Construction (labor, materials, Profit)
3
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Co Ilt% CZ052�
Property Owner Name
U Address
City/State Zip Phone
AjAr-oL
15n6jS F Q
ra.-d —
Applicant Name I
Address
city/state Zip Phone
Contractor
Address
'"�� - 777-j
C1-154
w. a.r,� Cry os3�
Contractor City of Ft Collins
Tax # zI
Are you paying taxes here or by report? prl:16 CI Report
balesfar number &nwL -edhyallmnbacWm
Are you paying with your trust account? ❑ Yes 010 �L
Is this a residential r crg1eRa,!miIy
project? dential ❑ Commercial
If residential, is it Detach ❑ Condo/townhome (single family attached) ❑ Duplex
❑ly (apartrnent) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Oftioe ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, youmayneedto con&KtHisioncpr onotlon
If this Is for a demolition permik what year was the building constructed?
Ifprlor to 1975, you wiUneed an asbestos assesunent La submlt witli drlsaPPrcafion. .
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subconbactors: Lathe companyname orGly offtCollinsGcense #
Electridar Plumber Medwniol Roofer Other
I hereby ackrimledge that I have read this appGmtion 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 buil& construction. I know that a .
permit is not valid until it has been paid and issued.
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