HomeMy WebLinkAbout4436 CRAIG DR - APPLICATIONS - 2/17/2015City of
F®r$ Collins
OVER-THE-COUNTER
Planing, Development & Transportation
281 N"L. College Ave P.O. Box 580
Fort (�OIlinS, CO 80524
This application is to be used to apply for the following permits
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not sen
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑
❑ Ventilation ` 9 Water Heater ❑ Water Line ❑ Wood/Pellet Stove
manufacturer).
Complete all applicable information on the application. Incompl
Application # 131501)
For ofte use only
970-416-2740 Fax 224-6134
ITS ONLY
(check all that apply). ❑ Air Conditioning
change) ❑ Gas Lighter ❑ Gas Log
>fing ❑ Sewer Line ❑ Photo -voltaic
st be EPA certified, provide make, model and
applications will not be accepted.
z/l-7/J5
lob Site Address (required)
4a3� ,ram.; Y
Value
;I;
of Construction (labor, materials, profit)
Property Owner Name
Address
City/S
tate Zip 05a Co Phone ct'—TD
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Applicant Name
Address
City/State
L_") I -
Zip Phone R] 0
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Contractor
Address
City/S
toZip b0 5'3l Phone TW
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I-Cuz . LDS La".
Contractor City of Ft. Collins Sales Tax #
Are you payin
,
taxes here or by report? ,0 Here ❑ Report
SNestax number isrequired byall rontractors
Are you payin
j with your trust account? VP Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commer
If residential, is it: Single Family Detached ❑ Condo/townhome (:
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Me
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, yourr:
If this is for a demolition permit, what year was the building constructer
Ifpnor to 1975, you will need an asbestos assessment to submit with this
Description of work �5><�
*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
family attached) ❑ Duplex
office ❑ Office ❑ Retail
need to contact Histonc,preseruation
must list licensed electrician.
Roofer Other
I hereby acknowledge that I have read this application and state that the abov� information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state lads regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: C 141 ). VV h (_d)
n
Print Name: f 14 � Signature /mil Ju tiL� Date I I ( 5