HomeMy WebLinkAbout6714 ANTIGUA DR - APPLICATIONS - 10/13/2015Oct 12 1511:46p Ellmann Service Cc 9702233324 p.1
Planning, Development &Transportation
�l ty p 261 N. College Ave P.O. Box 580
Fort CoWns 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). 0 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 ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
complete all applicable information on the application. Incomplete applications will not be accepted.
Application #. ��J��� J Date
I-vr u11JCtl we vnkr
Job Site Address (required) l Value of Con5tructfon (labor, materats, profit)
torn ��• �3$ g l 2•17.02
ty/ Ci 5tate Zip Pho �?
Property Owner Name Address
is �r Cdifns. (ZPD 80 2S
Address City/State Zip Phone
Applicant Name _ r r
Contractor Lic # Address Ci nlState Zip Phone
i�li,ntl-:r�nl Si•'/.�a�c•:� /<..,.;: ���" %�� i 5 r��±�i2
Contractor City of Ft. Collins Sales Tax # 3y: vj Are you paying taxes here or by report? ❑ Here ('Report
cabs tax number isregtd2dbyall centrac!ars. Are you paying with your trust account? 'oyes ❑ No
Is this a residential or commercial project? ®Residential ❑ Commercial
If residential, is it: 01 Single Family Detached ❑ Condo/mwnhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
I` commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mot-2l ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ other(explain)
Is this building so years of age or more? ❑ Yes ❑ No if yes, you mayfwad to conactHistoric Preservation
If this is for a demolition permit, what year was the building consbucted?
if onor to 1975, you will need an asbestos assessnenr to submit w/th this applimrion.
Description of work �nS l f C'j chit AILW
*If lawn sprinkler/backRow preventer, must list licensed plumber. If first-time AIC, must lit licensed electrician.
Subcontractors: LLttiecompanynaineorGtyofFtCollinslicense
Electrician Plumber t tedtanical Roofer Other
I horeby acknowledge that I have read this application and state that the above information Is complete and correct. I agree to
comply with ali 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 Name: %�ft)���J�� GIL.+�.o. �. SignatuDate