HomeMy WebLinkAbout2430 CREEKWOOD DR - APPLICATIONS - 5/24/2016planning, Development a o ransportai ion
City,o 281 N. College Ave P.O. Box 580
F6r tol@ns Fort Collins, CO 80524
" Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMIT'S ONLY
T his applications is to be used to apply for the following pernits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter _)Zf Gas_leT_J25eJ'-&
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line, 0 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 # S140 27.1 Date �5%
For office use only
Job Site address (required) Value od Construction (labor, materials, profit)
21-4.3D C f-e_e KuUvycl hr-,ye.
Property Owner Name
Address City/State Zip
Phone
}. �`/
��(30 GrzcKaJ01d,
Applicant Name
Address f City/State , ' Zip c Phone
ir' !�G'�s .;Dj
L j
?
1 1_0—
y
Co tractor l is #
_ '} �
Address CitJ/State . Zips
v
r-% :/I` �� �-a � � ; l r� �� ��.� spy'—.• :'�C��Lt
Phone
� C• l l
r� � �j�!�
J
11�i�4_F�3 a i✓ —4 E L i 9
f
J �� t: V/i .Z— �� J,!%Or'I�J v� CG%:]� �Ji
J
Contractor City of Ft. Collins Sales Tax + Are you paying taxes here or by report? Here
❑ Report
Salesiaxnumberis2quibya//co�narco Are you paying with your trust account? ❑Yes
,� No
e
Is this a residential or commercial project? ErResidentiai ❑ Commercial
if residential, is it: O'Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel - ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
:Is this building SQ years of age or more? ❑ Yes ZNO _ fyes, you may need to contact Hisionc Preservation
if this is for a demolition permit, what year was the building constructed?
If"prior to 1975, you will need an asbestos assessment to submit with this application.
Description of
"If lawn sprinkler/bacMow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City ofFt 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. F know that a
permit ;s. not valid until it has been paid and issued.
Applicant: , C1.GC�
_
Print NaV$n�: JQ,r'%%/1 Signature
®ate ` /a 4// k