HomeMy WebLinkAbout6714 ANTIGUA DR - APPLICATIONS - 8/18/2015From:
08/18/2015 09:48 0215 P.002/003
City a Planning, !Development & Transportation
281 N. College Ave P.O. Box 580
t 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 Perrrr)ta on
13 Demolition (interior non-stnxduraij ❑ Electrical Alteration (not service change) eck a113 Gas l that Lighter ❑ Gas Lo0 Air g
O Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line O Photo-vohalc
Cl Ventilation p_Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable lriformation on the application. Incomplete applications will not be accepted.
Appllcation #T% i cir. LftA Af-
�calice UMCAV
Job Site AddrWs (mW#rd)
PmPerty Owner Name
L 2 J,iF I�
plicant Name
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contractor City of Ft Cc
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Address
Address
Address
Date_ 9-1
Value of construction (labor, materials, profit)
dry/State ZiP Phone
City/Stabe ZIT Phone 0110
S')-) is 4, a(�t'
GtY/State Z1p Phone 9-70
A
sales Tax 47 - airt
zwrracrtrs Are YOU Paying taxes here or by report? ❑ Here ❑
Are You paying with your trust account? PLYes ❑ No
Is this a residential or commercial project? Residential CI Commercial
If residential, Is It: 0 Single Family Detached d Condo/townhome (single family attadred) p Duplex
O Multifamily (apartment) Cl Garage
If commercial, Is It: 11 Bank 13 Bar 17 Church p Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant E] Other (expl in)
Is this building 5o years of age or more? O Yes iI No Ifyes, MU mayneerto mntact H1sftrie PheWVab0,0
If this is for a demolition permit, what year was the building constructed?
IfPlw101975, you $W1need an asbeslasassessmnt[osu&W Wffi ffi& ppygy�
Description of work
fS*Iuf lawn sprinkier/backRpw Weventer, must list Ik ensed plumber. If first-time AIC, must list licensed electrician.
boontraetorsr "St tkeroMA7nynamsoratydRCoAbu/iavrs:e,7
Electrioan----Plumber s Wchaniral�`
Rooter Other
I hereby acknowledge that I have read this applkation and state that the above Information Is complete and correct. 1 agree to
corn* with all requirements contained herein and city ordinances and state laws Permit Is not valid until it has been paid and issued. regulating building construction. I know that a
Print Nrrt —� �
Print Name: �
Signature cste Q - If j