HomeMy WebLinkAbout4700 INNOVATION DR - APPLICATIONS - 9/6/2019F&City of A' , P/arming, Development, & Transportat/on Services
t GOil11 s Community Development & Neighborhood Services
��-- 281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating UnV Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation IXWater Heater ❑ Water line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufactu
Complete all applicable Informationon
the application. Incomplete applications will not be accepted.
Application # IJ� vl 0 Date September 5, 2019
For office usear/y
lob Site Address (reqz&mq Value of Construction (labor, materials, profit)
4700Innovation Or C, Fort Collins, Colorado 80525 $3920.00
Property Owner Name Address City/State Zip Phone
Bryan Construction 4700Innovation Or Bldg C Fort Collins, CO 80525 970-377-0937
Applicant Name Address City/State Zia Phone
Christina Evans 1015 Link Lane Ft Co, CO 80524 494-7632
Contactor Address aty/Stake ZIp Phone
Allen Service 1015 Link Lane Ft Co, CO 80524 484-4841
Contradz)r City of ft Collins Sales Tax # Are you paying taxes here or by report? ❑Mere ❑ Report
&iesfarmazzbierAm m?dbyad canbar0ars Are you paying with your tint account? VYes ❑ No
10010
Is this a residential or erCial project? itRi=sidential ❑ Commercial
If residential, is it V Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Mul6iamity (apartment) ❑ garage
If commercial, is 1L ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other (explain)
Is this buikrmg 50 years of age or more? ❑ Yes ❑ No Ifyes you mayrreed to mrntactt6staric Pteservaon
If this is for a demolition permit, what year was the building constructed?
Description of work pen'°" ebsTinq 209 W/H in m1kq ma repl= phm ro We W/H (i of2)
*If lawn sprinlder/bac flow preventer, must list licensed plumber. If first-time A/C, crust fist licensed electrician.
Subcoribactors: LlstHrecwrbaanynameorCRyofftCoNrisfcww#
f3ectriaw Plumber 14erhankd Room Other
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I hereby acknowledge that I have read this application and state that the above information is complete and correct I agree bn
earn* 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.
Applicants ChnsV&na Fvanb
Print Name: Signature Date
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