HomeMy WebLinkAbout645 STONEHAM CT - APPLICATIONS - 6/13/2016Ci lanning, Development & Transportation
�s JUL 19 1116 81 N. College Ave P.O. Box 580
Flirt CoW e ort Collins, CO 80524
BY: Phone 970-416-2740 Fax 224-6134
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 applicable information on the application. Incomplete applications will not be accepted.
Application # _04-OJ4 / 75" Date 0
For office use only
Job Site Address (required)
645 C-,
Value of Construction (labor, materials, profit)
'Ug41"
Pro erty Owner Name Address
City/State Zip U��a7� Phone ( �41
Applicant N me Address
A 'tl1•
l_1.?(
City/State Zip Phone `17 0
L
Contractor J 1 Address
City/State Zip b05 j-� Phone
J J yy
L bill il.� ` 1•-"I i tn7 •7
{
•1-��i �� -�-1'
Contractor City of Ft.. Collins Sales Tax #
Are you paying taxes here or by report? 0 Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ID Yes ❑ No
Is this a residential or commercial project? )p Residential ❑ Commercial
If residential, is it: 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 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?
Ifpnor to i975, you wi//need an asbestos assessment to submit with this application.
Description of
IT lawn spnnwer/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft 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. I know that a
permit is not valid until it has been paid and issued.
Applicant:
C i !� :;Z i L, i ; : Date f 2 / (0
Print Name: y c ✓ Signature("i ! � -�1-- ; �� .1: � . �,_ ���- � .
02