HomeMy WebLinkAbout1809 GOLDEN WILLOW CT - APPLICATIONS - 11/22/2017Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 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 ❑ 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 # 6 '11-1O 101,oQ. Date
For ofte use only
11 /22/2017
Sob Site Address (required)
Value of Construction (labor, materials, profit)
1809 GOLDEN WILLOW CT
$3390.00
Property Owner Name Address
City/State Zip
Phone
SCOTT MCINTOSH 1809 GOLDEN WILLOW CT, FORT COLLINS CO 80528
970-204-1455
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
NORTHERN COLORADO AIR INC 812 STOCKTON AVE, FT COLLINS CO 80524
970-223-8873
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
0 Here ❑ Report
Sales tax number Is required by a//contactors
Are you paying with your trust account?
0 Yes ❑ No
26862
Is this a residential or commercial prolect7 El Residential ❑ Commercial
If residential, is it: 0 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 0 No If yes, you mayneed to contact HistnricPresemabron
If this is for a demolition permit, what year was the building constructed?
Zfprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work REPLACE
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst bye company name or Oty of Ft Col/Ins 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: KARENA m
m ,.a
Print Name: KARENA HUNTWORK Signature HUNTWORK Dam 11/22/2017
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