HomeMy WebLinkAbout624 N BRIARWOOD RD - APPLICATIONS - 9/7/2018From. SCOTT EVANS Fax: (888) 503-7201 To: Fax: (970) 224.6134 Page 2 of 2 09/072018 12:26 Pt,1
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�6 W[Ins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80624 Main: 970.416.2740 Fax: 970.224.8134
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 Aiteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement XRoofing ❑ 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 pplication. Incomplete applications will not be accepted.
Application #TD I K) Date
Fn niirrp im on/V
Sob site Address (required) Value of Construction (labor, materials, profit)
b A). $r:ur d A, O 8
Property owner Name Address City/State Zip Phone
r: l cf. f2w—j 62110K, 60 90 q70-(a31-7v3
Applicant Name Address City/state Zip Phone
Wi' n C dos►b 303• y!
Contractor Address City/State Zip Phone
At Reago'!4Box 39 7 CO $o516 393, YY • 5537
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here l7 Report
sales &xnumber ' brequby allcontractvis: Are you paying with your trust account? ❑ Yes ❑ No
4:2 — —7
Is this a residential or commercial project? 10 Residential ❑ Commercial
If residential, is it: bd single Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: [IBank ❑ 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 Pressrvadon
If this is for a demolition permit, what year was the building constructed?
Description of work o • ¢ r Q 1
�r
NV V
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& die comaany name or G•ty offt Collins license #
pectrician Plumber Mechanical Roofer ' j b 97 Other
I hereby acknowledge that I have read this application and state that the above information is complete and correcL 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: W�5. eo if E Uon., Signature k/ ` ��° care FF —
Revision data 2/612017