HomeMy WebLinkAbout4349 KINGSBURY DR - APPLICATIONS - 11/11/2015NOV-11-2015(WED) 12:57 P.001/001
Cit of Planning, Development & Transportation
2B1 N. College Ave P.O. Box Sao
Fort Collins Fort Collins, CO 60524
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�r`,.nodltl ning
Demolition (Interior non-structural) Electrical Alteration (not service change) Gas Lighter trGas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo-ttai
Ventilation Water Heater Water Line ilyood/Pellel Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on tho application. Incomplete applications will not be accoptod.
Applicaiaon # B IS O'O I5 Date[ l N C>i 7,0 [5
Foro(fn:e use only
Job Site Address (mcruired)
Property Owner Name
Applicant; Name
Contractor
W 12sMrzO Fiac-nAce
Value of Construction (labor, materials, profit)
Address City/State Zip Phone
Address Clty/State ZIP
Addrocc aty/State zip
14-1013 9WS2SLDC- ot, r=.e,/co ftW,4
contractor City of Ft Collins Sales lax #Are you paying taxes here or by report? Here
sa�aXnMbErrsrcawmibyall QXtraenxx (, Are you paying with your trust account? Yes
Phone
Phone
Is this a residential or com�m�er -%aparten'ip
lla[�Commereiat!f residential, Is it: Iem FahGendo/townhome(single family attached) Duplex
MultifamllGarage
If commercial, Is it: Bank Bar Church Hotel/Motel Medical office ONtce Retail
Restaurant Other (explaln
Is this building 50 years of age or more? Yes p �Jl'y you may need to ctsrrtact HisroricPrescrvaGon
it this Is for a demolition permit, what year was the building constructed?
1f prior to J975 you will need an asbestos aSrisment to submr't w/th this application.
Description of
'It lawn sprinkler/biacktlow preventer, muM list licensed plumber. If rim —time A/c, must fist licensed electrician.
Subcontractors: Ust the com/:0rry name or 0ty eollat8lieenst o
FJcCrleien
Plumber MechanldRt:oter�
1 hereby acknowledge that I have read this application and state that the above Inrormadon 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 notvalid until It has been paid and Issued. kek-h,-,-- c. W'e�S*4-L 41e"e- place.
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Applicant: �` . I
Print Nerne: t� (`�rG Signature C � �l N0 S
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