HomeMy WebLinkAbout4326 MESAVIEW LN - APPLICATIONS - 2/5/2015Fort 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 El
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # R, (S D 0(a It Date a 5 l
For obYce use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone q 70
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t e5o_o f143 ( C'DN� '0((: CO. -60
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plicant N me Address
City/State Zip
Phone
ct Gxo VV•J, q0IZ1 �.,ws�ak��r, tdv�l���l'u co.`M15, 770-6
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Contractor Address
w City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
Sales tax number isrequiredbyall contractors,
Are you paying with your trust account? ❑ Yes
X] No
Is this a residential or commercial project? 'AResidential ❑ 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 may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? 111
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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 Plumberal i_ H 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: �1
Print Name: Li mo&6., t Vm SignatureL,,.,,S�',L1Date
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