HomeMy WebLinkAbout4249 WINTERSTONE DR - APPLICATIONS - 9/25/2014Planning, Development & Transportation
city Of 281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 ^ J
OVER-THE-COUNTER PERMITS ONLY l`J
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 # Tl ` + 0 E5 ` S(o
For office use only
Job Site Address (required)
Date
Value of Construction (labor, materials, prof /': N,.
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Property Owner Name
Address
City/State
Zip
Phone
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Applicant Name
Address
City/State
Zip
Phone
Contractor
Address
City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
5a/es tax number is required by all contactors.
Are you paying with your trust account? * Yes ❑ No
Is this a residential or.commercial project? .Residential ❑ 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 5o years of age or more? ❑ Yes o 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 app/ica'yon.
Description of work &*�Oete, �-
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
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Subcontractors: List the company name or City of Ft Collins license
FJectridan 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: Date
Print Name: tll Tg ei signature'