HomeMy WebLinkAbout4809 CHIPPENDALE DR - APPLICATIONS - 1/26/2015Fort 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 ❑ 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 # i SOO4:e -2--, Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
So9 cr1/PPZS,A/019
10R7L C0111luS 9052,6 2 2.893
Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
T
9J7- 900 7
Contractor Address
City/State Zip Phone
2T S 0 "O'R Bo
5. e/11,06-1101"I 80$9 9
Contractor City of Ft. Collins Sales Llax #
Are you paying taxes here or by report? ❑ Here ❑ Report
sales raxnumber isrequiredbyall mnt-actors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? O 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 50 years of age or more? ❑ Yes ❑ No 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 application.
Description of work_ 96MO v'E eX/S 7iyC S --vC ltr�5 O� 1� iS'f R�✓�
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*If 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 X 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:
Print Name: J;9 ry?45�5 _5iiinature