HomeMy WebLinkAbout4425 STONEY CREEK DR - APPLICATIONS - 8/27/2012City of
F6rt Collins
Planning, Development & 7ransportation
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) 0 Electrical Alteration (not service change)- ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Cl 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 # tb'� I 1 G
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Date S o2% 4:;z
Job Site Address (regvor"
Value of Construction (labor, materials, profit)
Ppapirty Owner Name Address
City/State Zip Phone
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Applicant Name Address
Clty/State Zip Phone
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Contractor Address
City/State Zip Phone
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CG 10624
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report.? L7 Here AlReport
s taxrumrl r&e4vtkvidbyayow*adars.
Are you paying with your trust account? V Yes ❑ No
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Is this a residential or commercial project? Residential 0 Commercial
If residential, is It: ❑ Single Family Detach d ❑ Condo/townhome (single family attached) C3 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: Q Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No lJfyeli pv mWneed toarrtaci H&b*P` +an
If this Is for a demolition permit, what year was the building constructed?
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Description of work
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me mnpwynvm cr0TyoF.f
Electrician _ Plummer 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 Name:
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