HomeMy WebLinkAbout4425 STONEY CREEK DR - APPLICATIONS - 11/18/2017City of Planning, Development, & Transportation Services
F6rt 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 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
❑ 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 #
For office use only
Date I I //Q It -7
Job Site Address (required) Value of Construction (labor, materials, profit)
�q-255-6w Creek Ja, L'o l i n k`%
Property Owner Name Address City/State Zip Phone
h` i1 ire.. FE.Cold �5 q?o-
pplicant Name Address City/State Zip Phone
Narkem CO %mAjho I Pra in Aell E, Pulber 5V F� Codll (v 905� o--q8+ _40
Contractor Address City/State Zip Phone
kRu 51. Pt. C.D G 605zS 92)-4W/ 6
Contractor City of Ft. Col rins Sales Tax # Are you aying taxes here or by report? ❑ Here XReport
Sales tax number is required by all contractors. Are you paying with your trust account? ;6 Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: fji(,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? ❑ 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 ine 'Peja, eP_m �1f
*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 A'i p57 °I 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: j'� , \
Print Name:'`') &_ >,/' A _ Signature Date —11//$_
Revision date 2/6/2017