HomeMy WebLinkAbout6107 PHEASANT CT - APPLICATIONS - 2/11/2016Planning, DelialopMen't & Transport.a Lion
- '- 281 N. College Ave P.O. Bo,x580
Fort Collins, CO 80524
Phone 970-416-27-10 Fax 224-6134
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This application is to be used to apply for the folioviing permits only (check all that applyA-rD
it Conditioning
• Dan;olition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas LightGas Log
❑ I -leafing Unit ❑ Lam Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
i11,-1;ufactureLr).
C-oma plote ':I applicable information on the application. Incomplete applications will not be accepted.
/-1pphcation 4- /'ll�y(�Date_—/�r��0 _
For office use only
Sob Site AC -'ress (reguiiad) Value of Construction (labor, materials, profit)
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property Owner Name Address City/State Zip Phone
Applicant Name- M1�' Address City/State Zip Phone
Contractor -] Address City/Stater)y'Z//ii�p Phone / l
—ill / O!I (? P JV . 5. • ii f,✓ Gi �� 1 r� �� Zl cS �� /
' Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
i:,;_.> taNlwinberisfiogtdredbyall cvntractors. Are you paying with your trust account? 'tYes ❑ No
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Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
,j Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years oo aga or more? ❑ Yes ❑ No Ifyes, you mayneed to contact H/stodcPreservation
If this is for a demolition pernift, what year was the building constructed?
If/vior to 1975, you will 7e d an asbestos assessment to submit with this application.
Description of work—
:':If lawn sprinkler/backnow pr�must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Listmecompanyname orCityofFtCollins license 11
Electrician____ Plumber Mechanical Roofer — Other
r horeby 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 }m0101thEt F.
permit is not valid until it has been paid and issued.
Applicant: � � �� , 1 % 1
Print Namet .._.! io (�-, b UQ o �'!s.3 Signature / " � ut / °m ate---