HomeMy WebLinkAbout648 HEATHER CT - APPLICATIONS - 8/31/2018City of
Fort Collins
Planning, Development & 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 CanrjqfiQning
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter , Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -
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 # I&1 MI510 Date -2 ► i $
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
(p t 1 11t-A=c rtC�2_ c
3 `A20 ,cep
Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
Gty/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here a ort
Sales tarnumber isrequired byail mntractom
i-4
Are you paying with your trust account? Yes o
Is this a residential or commerce o'ect? si ential Commercial
If residential, is it:, n e Family tached ondo/townhome (single family attached) Duplex
Multi aml y apartment) Garage
If commercial, is it: Bank Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explain
Is this building SO years of age or more? Yes RD If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work r.rE..l G-AS I N > CI),-r I r'j7-D L C GL.;m, ^4 (T
r � fLE. P I-AC-E, • iZ � N �., �-t L,a S �� r.+' c f=i-z-� r %� F�.-t. ,v �-e�.
*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 B
Electrician Plumber
Mechanical Roofer Other
i nereoy 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: rr11 ✓� I
Print Name: L'�Ry" 1�AUV Signature
Date 613 i 118
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