HomeMy WebLinkAbout4306 CAPE COD CIR - APPLICATIONS - 11/3/201411/03/2014 14:27 3039352606 METRO PAGE 02/06
FCf
ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-C )UNTER PERMITS ONLY
This application is to be used to apply for
0 Demolition (interior non-structural) ❑ Elea i
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile I
❑ Ventilation ❑ Water Heater ❑ Water Line
manufacturer).
Complete all applicable information on the
Application # 'F>14-1 7.1 S(
For office use only
Job Site Address (required)
4soto o Q
Properly Owner Name Addn
Ap Ilcant Name J Ad n
Contractor Ad
Contractor City of Ft. Collins Sales Tax #
So/es tax number Is mgvlmd by all co tractors.
e following permits only (check all that apply), ❑ Air Conditioning
;al Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
ome replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
7 Wood/Pellet Stove (must be EPA certified, provide make, model and
pplication. Incomplete applications will not be accepted.
Date
Value of Construction (labor, materials, profit)
9
s City/State
Zip Phone
s City/State
ZIP Phone
4-
s City/State
M Rr, vte �)
Zip Phone
Are you paying taxes h
re or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or Spinmerdal project? esidential ❑ Commercial
If residential, is it: ) Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Chun: ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other explain)
Is this building 50 years of age or more? [IN, i ❑ No ffyes, you may need to contact Himmyc Preservat/on
If this is for a demolition permit, what year w: the building constructed?
IPpr/or to 1975, you will need an asbes(ps as5a . rient to submit with this application.
De§pription o work 'ic r
UTAIPn rYla 5Y)i e5:
*If lawn sprinkler/baddiow, preventer, must list Ila ied plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust Oe company name or dty e : R Call/ns 1/tense 0
Oedridan Plumber — Mechanical Roofer Other
I hereby acknowledge that I have read this applika: n and state that the above information Is Complete and correct i agree to
comply with all requirements contained herein and i .y ordinances and state laws regulating building construction. x know that a
permit Is not valid until it has been paid and i wed.
Print Name;—LfSh-2111 �3"E' SI I tature Date