HomeMy WebLinkAbout4454 STARFLOWER DR - APPLICATIONS - 1/12/2018City of Planning, Development, & Transportation Services
Fort 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 apniv for the following permits only (check all that apply). A. it Conditioning
Demolition (interior non-structural) t= Electrical Alteration (not service change) 1Gas Lighter t; Gas Log
.s Heating Unit w= Lawn Sprinkler ITMobile Home replacement i= Roofing &Y Sewer Line ai Photo -voltaic
.6 entilation +$ ater Heater MVater Line 1;9 ood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted. 4� t ��&
Application # �I f36(> 3 �� Date 1 11 L � IF
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit) WSJ
Property Owner Name
Address City/State Zip Phone
�G� •� ( 4 LJ Att+ O 05
Applican Name Address City/State Zip Phone
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Contract r %N Address City/State Zip Phone &
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Contractor City of Ft. Collins S61es Tax # Are you paying taxes here or by report? 4Here ffReport
Sales tax number is required by all contractors. Are you paying with your trust account? k. Yes UtNo
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Is this a residential or commercial project? E Residential 191Commercial
If residential, is it: �5ingle Family Detached €F Condo/townhome (single family attached) €F Duplex
sP Multifamil (apartment) s arage
If commercial, is it: `° Bank F° Bar F° Church F° Hotel/Motel 90Medical office F° Office F° Retail
6[ GG GF GF LF GF GF
s8 Restaurant LF Other (explain)
Is this building 50 years of age or more? [t Yes GG 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 rzpa-42 - TfAc zr _0 �.a nil -,� C ' PSG. rr, %1- ( I
p. k 1 .
*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 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:
Print Name: Ue rAthv' Signature Date�74 —
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Revision date 2162017
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