HomeMy WebLinkAbout2924 TUMBLEWEED LN - APPLICATIONS - 8/23/2016FCity of Planning, Development & Transportation
(5r g .Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THEmCOUNTER PERMITS ®N
This application is to be used to apply for the followin ��
Demolition (interior non-structural g permits only (check all that a I Electrical Alteration (not service change) pg to Air Go.nditis�ning
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing g) Gas Lighter C "Gas Log
Ventilation Water Heater Water Line 9 Sewer Line Photo=lroltaic- -,
manufacturer). Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete a 1'
Application #
For office use on/y
Job Site Address (required)
-%A—.,
Owner Name Address
[,1 Lo � 0-a -
cant
Contractor i
-u .e IL:
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contra
pp ications well not be accepted.
Date
Of Co
n
struction (labor, materialspfit)r profit)
hlrl
City/State Zip
Address City/State
Address City/State
Phone
Zip Phone
.. Zip
Are you paying taxes here or by report?
Are you paying with your trust account?
Phone
0
Here � ke ort
Yes No
Is this a residential or commerci �Q�
If residential, is it: in Fa mil den ' Commercial
Condo/townhome (single family attached) Duplex
If commercial, is it: Bank amily6(apartment) Garage P
9
ar Church Hotel/Motel Medical office
Is this bRestaurant Other (explain) Office Retail
uilding 50 years of age or more? If this is for a demolition permit, what Yes year was the building constructed?
No If yes, you may need to contact Historic Preservation
IfPrior to 1975, you w/// need an asbestos assessment to submit with this application.
Of work
If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must li
Subcont ctors: List the company name or C/[y of Ft Cst licensed electrician.
o//ins license Electrician , V
Plumber �-�— -
Mechanical �—
Roofer Other
I hereby acknowledge that I have.read this application and state that the above information is complete and c !—
comply with all requirements contained herein and city ordinances and state laws regulating building construction
permit is not valid until it has been paid and issued. correct. I agree to
�1�in� /�/�1I g know that a
Applicant: 1 1 ���1 vv �I�/� j� r� Print Name. Srr_, V l /� r
Signature 11 -•Y.l'
Date