HomeMy WebLinkAbout4700 WHEATON DR - APPLICATIONS - 1/12/2016Planning, Development & Transportation
city cf 281 N. College Ave P.O. Box 580
F6r ` Colons Fort Collins, CO 80524
/11� `- Phone 970-416-2740 Fax 22+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 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 appliiccablle_ Information on the application. Incomplete applications will not be accepted.
Application # L J� l�D ���y' Date
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
4Ir?Ob
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Proerty Owner Name Address
City/State Zip
p
Phone
m &,} A �lQvac.to 16l1
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Applicant Name Address
Gty/State Zip
Phone
c2nodor Address
813
City/State Zip
2� l �3
Phone
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Contractor City 'of Ft. Collins Sales Tax #
Are you paying taxes here or y report? ❑ Here Report
trust ❑ Yes VNo
Salesraxisrequiredbya//contractors,
numberT2-
Are you paying with your account?
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Is this a residential or commercial project? ❑ Residential Iiil Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hobe/ otel ❑ Medical o�ce 13 Office ❑ Retail
❑ Restaurant IYOther (explain) TSr M,+c W & 61 "Ilk
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you WY need an asbestos assessment to submit with this application.
Description of work �' Lg(Y,nr cp /mil/(_ y ii
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: Ustdre company name or City of FtCollins/icense 0
Eleoridan 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.
Print Name: h MI C ✓ & Li,, Signature
Date _ ,2-126lto .