HomeMy WebLinkAbout809 SNOWY PLAIN RD - APPLICATIONS - 10/23/2017Da RFRF Planning, Development, & Transportation Services
l t8thns 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 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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilations Water Heater ❑ Water Line ElWood/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 #,
I� l'10-1 OtFl
For office use only
Date 10/2-3117 S`b •1"1
Job Site Address (required) Value of Construction (labor, materials, profit)
oil led
Property Owner Nyme Address City/State Zip Phone
�09Y� W(aiJ 3aan 1. 27o
plicant Name Address City/State Zip Phone
1JUA i11 MaU 7230(7�N %`(l'0441 `1 8022q S03--965Z5
Contractor Address Cl /State Zip Phone
Coloracle � �, -7o3o(4*r �(U eZZ9 3a3-66
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by reportrt. ❑ Report
m vere
sales faxnumber isrequired toy all con&actors. Are you paying with your trust account. ❑ Yes ❑ No
Is this a residential or commercial project? _6i'Residential ❑ Commercial
If residential, is it: MrSingle 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? ❑ Yes ❑ 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 work
Q/J
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Cny of 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: I /
Print Name: i(r I� iignature _ Date z
Revision date ZWM17