HomeMy WebLinkAbout4436 STONEY CREEK DR - APPLICATIONS - 12/20/2017>� Of
/11 F6rt Collins
Planning, Development bh Transportation
281 N. College Ave P.O. Box 580
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). ❑ 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 SffWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Dinformation on the application. Incomplete applications will not be accepted.
Application # B l'I I (DoZ- Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner a Address
City/State Zip Phone
pplicant N me Address
Ci /State Zip Phone
abut,z4v 41VI rL Q
r Address
/State Zip Phone
Contractor City of Ft. Collins Sales #
Are you paying taxes here or by report? ❑ Here OReport
SBks tax nwnbey-IsrequUedbyall mnVactors
Are you paying with your trust account?,ZYes ❑ No
Is this a resrdentral or c9mmercial project? El Residential ❑ Commercial
If residential, is it: 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 (expla n)
Is this building SO years of age or morel ❑ Yes �No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the budding constructed?
Ifpnor to 1975, you wil/need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft 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 pail and Issued.
Applicant: Print
�.4J71 �l-y-
PrirttName: Signature Date