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HomeMy WebLinkAbout6315 TREESTEAD RD - APPLICATIONS - 11/4/2014 (2)Plannng, men City of �Lli/ 1 tl GIJ 1`] 281 N iColl College Avep P Ot Box 580sportatlon F&rd ®Wns — Collins, — ____ Phone Phone970-416-274040 Fax 224-6134 ®E'ER 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 14 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation 0 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 # (614 122)3 For office use only Date II /.4I 14 Sob Site Address (required) 1'61 521. S--ta'L_ 12� -J • Value of Construction (labor, materials, profit) cb_w Go 8()5�)-b -1 S(044. Property Owner Name Address City/State Zipr�-So�N� Phone 9 ° G � I�/p/ )5 r'It c 1o�,1 J . ui 0 OH 1, 7- Applicant Name Address City/State Zip Phone ri C{n� \lvnc4�t =°13�I�11, sr (�bf, o}tLaui, �s ���ri�i ��v-liov Contractor l Address City/State Zip 36531 Phone 6'7-70 '1zL' J.e 11 ' S I�f 1 (i n ; %= i r �J 7 J =�:rvv-� v ! t'vL.l« l� ��o - I 1 Gv Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? © Here ❑ Report sales tax number is required by all contractors. Are you paying with your trust account? OYes ❑No Is this a residential or commercial project? Ti Residential ❑ Commercial If residential, is it: P 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 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you will need an asbestos assessment to submit with this application. Description of work L J TIf lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license # Electrician 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: C t is G \N s. l G t Print Name: i Signature Date t I /� l 17