HomeMy WebLinkAbout3858 CENTURY DR - APPLICATIONS - 1/2/2018Clt Of Planning, Development & Transportation
FortFortCollins 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 n
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter r"GsLLog \ing
a
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Pho.6-voltaic--f
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 # 1?;1 000l 7 Date
For office use only
is this a residential or co ci Lpro ct� Residential Commercial
If residential, is it Single Family Detache `�, Condo/townhome (single family attached) Duplex
Mu tifamily (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 uilding constructed?
if prior to 1975, you will need an asbestos assessment to submit with this appbcadon
Description or work
I o e fi'r-i^r•i tl4
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Itrir- f i D'i �} it ^'(I Ct{ilyi I'l v
`if lawn sennFler/backflow preventer, must list licensed olurnber if First lime, A/C, must list hcersed elcctnc.ar,
Fri
subcontractors. L,st the Company nave of City Of Ft Collins license r
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r'IeCnaan__11t`L f CAI' 1- ric, 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 budding construction I know that a
permit is not valid until it has been paid and issued
Applicant. I J fr
Print Name l `l'-� Signature---: �{ (_ Date