HomeMy WebLinkAbout4615 DUSTY SAGE DR - APPLICATIONS - 8/17/2018`a\QP��
City of Planning, Development, & Transportation Services
,art Collins Community Development & Neighborhood Services
281'North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). k47Air 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 ❑ 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 #_ S I SO(o°l S5 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
L�affs - 3
Property Owner Name Address City/State Zip trl
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Applican ame Address ity/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
Sales tax number isrequired byall rontractois. Are you paying with your trust account? 14:(es ❑ No
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Is this a residential or mmercial project? esidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) [I Duplex
fj Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building s0 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Histofic Preservation
If this is for a demolition permit, what year was the building constructed?
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 Collins license #
Electrician 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:
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Print Name: S lNc �F . G'% -\x' Signature �g�,9 �%v� Date O �1i1.0
Revision date 2r/2017