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HomeMy WebLinkAbout6708 ANTIGUA DR - APPLICATIONS - 11/15/2016City of Fort CoWns' Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 701 >�_ T Phone 970-416-2740 Fax 224-6134 a , �ruo -v OVER-THE-COUNTER PERMITS ONLY ! 4t, 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 >S1 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 # Date ((_15, —01 (D For office use only ? 56 Job Site Address (required) Value of Construction (labor, materials, profit) lqj ©e3 kr)-fiua DC Uk n'I +- U 0 f_-+ W (ins CO /io© rty Owner Name Address PZlq'GLn City/State Zip Phone 0 vyi ins lsl Db lk fi u a b r (po W C(h n s q off- (4ZO Applicant Name Address City/State Zip Phone 97 O Jacob -Kempf 2-3 i O Min V i e vv C)r LU Ve (a no Co S Uc-3 g B (-)-cxiy Contractor Address City/State Zip Phone f7 0 i r (,(e gi u,e 1'�Aec1-jcx n(,ccd U__c PC 8c X 1 q r; 3 Co 8003q ?)I t_0Q4_ Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here R Report Sales tax number is requiredb all contractors Are you paying with your trust account? ❑ Yes RNo Is this a residentia(or commercial project? X[Residential []Commercial If residential, is it: ❑ Single Family Detached Z 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 ,M No If yes, you may need to contact Historic Preserization 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. of work *If lawn sprinkler/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: �� rf) K � Print Name: U Date I It5tv 900 QaCA