HomeMy WebLinkAbout4719 CREST RD - APPLICATIONS - 1/15/2015Planr iing, Development & Transportation
City OS 281 N. College Ave P.O. Box 580
_ F®rt CoRins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER !s!y7(chec'kTa1S1that
MONLY
This application is to be used to apply for the following permiapply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not servi a change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ ofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation `(E Water Heater ❑ Water Line ❑ Wood/Pellet Stove ( ust be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplet applications will not be accepted.
Application # �w t<� Date
For office use only
]ob Site Address (required)
Value
of Construction (labor, materials, profit)
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Property Owner Name Address
City/
tate
Zip Phone f1 O
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Applicanft' Name Address
City/
tate
Zip Phone ell `�
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Contractor J Address
City/E
tate
Zip '100 5 '�l Phone 9 -1 u
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Contractor City of Ft. Collins Sales Tax #
Are you paying
taxes here or by report? P Here ❑ Report
Sates tax number is required by allmntractom
Are you paying
with your trust account? 177!Yes ❑No
Is this a residential or commercial project? Wesidential ❑ Commercial
If residential, is it: OSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Mahcal office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructe ?
Ifpnor to 1975, you will need an asbestos assessment to submit with this Oppllcatwn.
Description of work s 4 c�e�
�dx ✓
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical
A/C, must list licensed electrician.
Roofer Other
I hereby acknowledge that I have read this application and state that the aboda information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state la vvs regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:, ; /
Print Name: i (� iy7 Signature /(Z_ ✓ {� -A ( V14 Date ( I