HomeMy WebLinkAbout4213 BEAVER CREEK DR - APPLICATIONS - 6/15/2016This application is
❑ Demolition (interii
❑ Heating Unit ❑ 1
❑ Ventilation ❑ We
manufacturer).
Completei all applic
Application #,
Planning, Development.&Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
THE -COUNTER. PERMITS ONLY
i be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
wn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
r Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
information on the application. Incomplete applications will not be accepted.
I(oo?�a- o
For gi1%e use only
Date __ Z to
Sob Site Address (required)
Value of Construction (labor, materials, profit)
LJ 24 CmeJc- 1'-"te
Co
Property; Owner Name Address
City/State Zip Phone C'1/2 —
ful CSC 2/
c r
Applica t Name Address
City/State Zip Phone
Contractor. Address
City/State Zip Phone
Contractor City of Ft.Collins Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number is required by all contactors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or ;co erdal project? Residential ❑ Commercial
If residential, is it: IrSingle Family Detached ❑ Condo/townhome (single family attached) ' ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (explain)
Is this building: 50 yams of age or more? ❑ Yes ❑ No rfyes, you may need to contact Historic Preservation
If this is fora demolition permit, what year was the building constructed?
Ifprlor to 1975, you W//need an asbestos assessment to submit cwdh this application.
Description of
a,
*if lawn sprink1er/badd1ow preventer, must list licensed plumber. If first time A/C, must list licensed electrician.
Subcontractors: List die company name or Gly of Ft Collins license #
Plumber Mechanical Roofer Other
I hereby aOmowledge 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 laid and issued.
Applicant:ate-
Print Name: Signature e"
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