HomeMy WebLinkAbout6857 RANGER DR - APPLICATIONS - 5/30/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to a7mobile
for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (Interior non-structuralElectrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 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 # -50 0 a KT Date
For office use only
$ a DOD 100
Job Site Address (required) Value of Construction (labor, materials, profit)
4 6 8 `2-o e('10tr L co V6 q-70
Property Owner Name Address City/State Zip Phone
aPl b U44,oC CD 90f1p q-N i
Applicant Name Address City/State Zip Phone
3 12
Contractor Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report'? ❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes ❑ No
C-2 — 0 6
Is this a residential or commercial project? 12kesidential ❑ 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? ❑ Yesi No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of ork t�o.�e P\'eCA'.eJ
(a UAC( U e_KIf
*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 #
Electnaan /u >'Ya LA+ flift- Plumb 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:
Print Name )�!An i A IKX \' -A Signature Date �6 U )'
Revision date 2/6/2017