HomeMy WebLinkAbout925 QUAIL RUN - APPLICATIONS - 10/9/2017Planniitg, fleVelopment & Transportation
a 281 N. College Ave P.O. Box 580
Cot i Fort Collins, 16 80524
740
'"^'' Phone 970-416-2740 Fax 2246134
OVER-THE-COUNTER PERMITS ONVY
This aT lication is to be used to apply for the following permits only (rbeck all that apply). 0 Air Conditioning
p D ,olition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
Sewer Line U Photo-voaic
aafing Unit ❑ Lawn Mobile H
Line D W000me pd/Pellet Stove (must be EPlacement 11 Roofing A a
PA certified, provide keltmodel and
❑ Venblabon ❑ Water Heater 0 Water
manufacturer).
the applica#ion. Incomplete applications will not be accepted.
Complete all applicable information on
Application # v,I-D Lk
For otftce use only
Sob Site Address (required)
Address
Property Owner Name
plicant Game, _ I Address
Ap
Contractor Address
Contractor City of Ft Collins Sales Tax #
:L s iat number/ n nu/ JlbY al/ ronbactors
Date b
value of consEmcu)" Maw',
z
City/State Zip Phone
C,�a7� 493 - 6-7,31
k1st
� Zip Phone
City/State Zip Pher,r
Are you paying taxes here or by report? El Here � Ref
Are you paying with your trust account? Pas ❑ No
Is this a residential or mmerdal project? esldential ❑ commercial Duplex
If residential, is it: ingle Family Detached 0 Condoltownhome (single family -attached)
❑ Multifamily (apartment) ❑Garage
it commerdal, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ace Cl Retail
❑ Restaurant 0 Other (explain) you need to rnnr�dHlstorlcPreservadan
Is this building so years of age or more? Q Yes' ❑ No If yes, tr Y
if thls is fora demolition need mi , what
year
assessmenttowas the subming iwM this ppllcaffon.
if prior to 1975, y
Description of work
"if lawn sprinkler/backFlow preventer, must Irist licensed plumber. If first time A/C, must ILst licensed electrician.
Subcontractors: List the company name or City of Ft collinslicense # Roo rer. Other
Plumber� Medianical�
f 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 ]tnow that a
permit is not valid until it has been paid and issued. ) /j
Applicant: . 1IAl_'ran_,�lV�1G/ Signature C'• — ���I�
Print Name_, L T 0--