HomeMy WebLinkAbout4261 STONEY CREEK DR - APPLICATIONS - 10/1/2014Planning, Development & Transportation
City .Of281 N. College Ave P.O. Box 580
�r:4Qins,. 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 0 Mobile Home replacement ' Roofing ❑ Sewer Line ❑ Photo -voltaic
Cl Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide ftel and �l manufacturer). OCT. Q 2 zQry
Complete all applicable Information on the application. Incomplete applications will not be accepter(.}
Application # at 4'1 Za I I e _ Date
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, P,
fit)
hn 261
Sit
Creek �n in• 9o57.S - 1-
1 3
Property Owner Name
Address
City/State Zip P;
one
Applicant Name
Address
City/State Zip Phone
e-laeonsh ,m, 502a W.
t2ukh
Ave, k206 m2mkid - S 4 ;
87
Contractor
Address
City/State Zip Ph
one
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
Sales tax number i5rWiNr6dbyall contraciors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? Q Residential ❑ Commercial
If residential, is it: 11Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage.
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ ofice ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )dNo Dyes, you may need to contact H/stcr/cPreservaiY
If this is for a demolition permit, what year was the building constructed?
.if prlar to 1975, you w/l/ need an asbestm assessment to submit with this appl/cad'oA
Description of work
*If lawn sprinlder/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontractors: List the company name or Gty of fit Co/Ons 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. 1!' gree 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.
Print Name: Signature—r___ ___v