HomeMy WebLinkAbout609 JANSEN DR - APPLICATIONS - 11/21/2017o tin:
OVER.'
This ap lication is to be used to apply forthe following permits only (check all that apply). ❑ Air Conditioning
❑ D tolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Roofing
leafing Unit ❑ Lawn
Sprinkler
❑ WaterlineHome
❑ WoodlPellet Stove mu t be E❑PA certifieLine
pro❑vPhoto-voltaic
modal and
❑ Ventilatton ❑ Water Heater
manufacturer).
Y on the application. Incomplete applications will not be accepted.
p nnMq, Development & Transportation
1 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
Complete all applicable informa ion
Application # V iDD I - { 1
For office use only
Job Site Address 0-equfred)
�2%
Owner
Applicant Names, ^ "
Contractor,f Address
Contractor City of Ft. Collins Sales Tax #
Js csx numberls raqulred by all contactOrs
lDe9/B
Date 10 al 1 -
Value of Construction (labor, /materials, /profit)0
F6cit55 cUl 111 ��
y/ bZIP Phone
r o) o -Sill S-
City/State Zip Phone
city/state Zip Phone
Are you paying taxes here or by report? ❑ Here ' _JgReport
Are you paying with your trust account? 'Wes ❑ No
Is this a residential or corn erdal project? oResidential El commercial
IF residential, is it: [ngle Family Deta&eed\ ElCondo/townhome (single family attached) ❑ Duplex
Itifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hoiel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No Ifyes, You
may need to mntactHlsforlcPreservatlon
If this is for a demolition permit, what year was the building constructed?
rfpii,)r to 1975, you w1/1 need an asbestos assessment to submit with this app11ca6bn.
Description of work
"`IF lawn sprinkler/backflow preventer, must list licensed plumber. IF first-time taus
Subcontractors: List the rompany name Or City of Ft collins license if Other
Plumber Mechanical Roofer
Electrician___—. — —
t hereby adcnoroviedye 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 dty ordinances and state laws regulating building construction. i know that a
permit is not valid until it has been paid and issued.
Applicant: I�r(yN
Print Name., 1•-L •an_}: "-"""' Signature