HomeMy WebLinkAbout508 WINNIPEG CT - APPLICATIONS - 9/18/2018City 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
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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 ❑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 # G�C()0 001�)90
For office use only
Date
lob Site Address (required) Value of Construction (labor, materials, profit) 00
l> 9 lv� i "M C-X )rry C) G� 1± DO,
Property Owner Name I U Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address /State Zip Phone
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Contractor City of Ft. Collins Sales Tax Are you paying taxes here or by report? 123fHere ❑ RXort
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes 0
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Is this a residential or co/mercial project? Residential Cl Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hote(/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes t01Vo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
escription of work QX) 114.10 k 171. ' l.f _' LTV
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*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 C' 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 o a-, ��y V` S' � V V Print Name: ignature Date
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Revision date 2/6/2017