HomeMy WebLinkAbout4700 INNOVATION DR - APPLICATIONS - 9/6/2019 (2)Cityot Planning, Developmen4 & Transportation Services
Fort Whn$ Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO SM24 Main: 970AI6.2740 Fax 970224.6134
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 ` Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Water Heater 17 Water Line ❑ WoodlPdlet Stove (must be EPA certified, provide make, model and
manufactuU)
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # Nq D91 vl I
Form roe only
Date September 5, 2019
Job Site Address (mququhed) Value of Consbustion (labor, materials, profit)
4700Innovation Dr C, Fort Collins, Colorado 80525 $1.00
Property Owner Name Address city/State Zip Phone
Bryan Construction 4700Innovation Dr Bldg C Fort Collins, CO 80525 970-377-0937
Applicant Name Address Qty/State Zip Phone
Christina Evans 1015 Link Lane Ft Co, CO 80524 494-7632
Contractor Address Qty/State Zipp Phone
Allen Service 1015 Link Lane Ft Cc, CO 80524 484-4841
Coribachor City of IL Collins Sales Tax # Are you paying taxes here or by report? ❑,Mere ❑ Report
-qft biro h;mVbedbya#cmftc&s Are you paying with your trust amount? IWYes ❑ No
10010
Is this a residential or 9mmerd project? Residential ❑ Commertial
If residential, is it- V Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motet ❑ Medical office O Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes ❑ No Ifyes yvu maynced to cvnractffisivrrcAresenraii"vn
If this is for a demolition permit, what year was the building eonshvcted?
Description of work kemn e4s""94
0
' w/H in ®ling and replan with new Eke W/H (Z OU)
*If lawn sprtnkler/baddlow preventer, must Iist homsed plumber. If first-time A/C, must fist licensed electrician.
Subcontractors: list the compianyname orQy ofir Collins Gceaw 0
Sectridlari Plumber Medmnrnr Roofer Other
I hereby aclaxrMedge 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 /�lr9 g /� L!5r
Print Name: Chri via.r vawaSignaturec f, ii &i&Date
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