HomeMy WebLinkAbout912 CHEYENNE DR - APPLICATIONS - 6/19/2017Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-4162740 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). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line ❑ Photo -voltaic
O Ventilation ❑ Water Heater 0 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 # lb 1-10 35ce 5 Date 6 — /% — /
for o/I/a° aw a*
lob Site Address (mquked)
Value of Construction (labor, materials, profit)
Co%U 5—
Property Owner Name Address
aty/state Zip Phone
i
Applicant Name /gc�l/a n c 4e rJ Address
sty/amaec o i oo r BP 6V�D Phone �� 3
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Contractor Address
aty/state 7jpEma l Phone
`T�r 0,dk vc.,K Q, k 1114 1
I I vv\ C:L-, i
Contractor sty of FL Collins sales Tax #
Are you paying taxes here or by report? 0 Here ❑ Re rt
Saks Am number mreywredbyauwn&aceas
Are you paying with your trust account? ❑ Yes 0 No
Z;Z-cf (1) s- [„
Is this a residential or commercial project? 0 Residential 0 Commercial
If residential, Is It )?single Family Detached 0 Condo/tomhome (single family attached) O Duplex
0 Mutbfamily (apartment) 0 Garage
If commercial, is It: 0 Bank 0 Bar 0 Church 0 Hotel/Motel 0 Medical office 0 Office 0 Retail
❑ Restaurant 0 Other (explain)
Is this building SO years of age or more? O"Yes O No If yes, you may need to crnbd HBYw/c Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you rv/U need an asbestos assessment to submit xs'th ffi& appllcaMw•
Description of work
*If lawn sprifder/baddlow preverder, must list licensed plumber If flrst-time A/C, must Ilst licensed electrician.
Subcontractors: List the company name or sty of R Cafffts license 0 ^ n
ElecMdan Plumber Medianical (Rooter ��OtheP
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: 11
Print Name :> %. tir Jyl 1, (I INC k signature