HomeMy WebLinkAbout4112 WARBLER DR - APPLICATIONS - 9/24/2014FROM :NCR
FAX NO. :9702299983 Sep. 24 2014 08:28AM P5/9
Fort 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-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 13 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 #tia
Date -('�"�
For oirke use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
�T
L- Ik2- ✓J.LQ
2-406-
Property qwner Name Address
City/State Zip
Phone
"�?S CACA
Fle
Applicant Nanii Address
City/State Zip
Phone
Contractor Address
Gty/State J--Ca)1 IMZ1p
Phone '0-/"Ib .
or�+%� Vtn �alc�u >(�ir^ f he :? I ZS
Go RM 2-4 r
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
*ere ❑ Report
Sales taynumber Isrequired byall mntractom.
Are you paying with your trust account?
)yes 0No
Is this a residential or commercial project? EfResidengal ❑ Commercial
If residential, is It: Single Family Detached M Condo/townhome (single family attached) ❑ Duplex
9 Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant ❑ other (exew�jlldlng
)
Is this building 5o years of age or more? ❑ Yeso If yes, you may need to contact HistoricPreservation
If this is for a demolition permit, what year was t constructed?
If prior io 1975, you will need an asbestos assessment to submit with th/s appllcat/on.
Description of work
*If lawn sprinkler/bac0ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Gty of Collins license 0
Elearidan 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-
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