HomeMy WebLinkAbout967 WAGONWHEEL DR - APPLICATIONS - 7/20/2015FROM :NCA
FAX NO. :9702299983 Jul. 20 2015 03:14PM P1/3
Flirt 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) 0 Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ElMobile Home replacement ❑ Roofing ❑ Sewer Line El Photo -voltaic
❑ Ventilation 0 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 # ISOSLI O_l Date
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Namej Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address Cily/State F�CA klhcZip Phone c`71b
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? .KHere ❑ Report
sales tax number lsrmulredbyall mntractom Are you paying with your trust account? des ❑ No
' l-0gl0a
Is this a residential or co mercial project? Je-Residential ❑ Commercial
If residential, is it: Ingle 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? 13 Yes No Ifyes, you may need to contact Historic Preservotlon
If this is for a demolition permit, what year was t bullding constructed?
if prior to 1975, you will need an asbestos assessment to .submit with thls appllcafion.
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 Collin 11cense #
tlectrldan _ _ ., Plumber___ 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:
Print Nam
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