HomeMy WebLinkAbout3557 BEAR RIVER CT - APPLICATIONS - 9/26/2018City 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 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 hoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
complete all appl le i o on on application.
Application #
krIMCiusyonly
Incomplete applications will not be accepted.
Date R 6 18
]ob Site Address (required) Value of Construction (labor, materials, profit)
55,�7 1Vec C_4 Co 8ps�r4 1 o —
Property Owner Name Address City/State Zip Phone
SIB -a 'S#Me AS A-6vt
Applicant Name Address City/State Zip Phone
5L's4 A INLa,r� 33 N• pit s ti Aqk Lod .B ',To 6Aw v, c o Sas3Y qr;b - a1a - q 1'73
Contractor Address City/State Zip Phone
C1A A05 CrAuIak, (:!evlS�r_tk v✓I 33 N. prls% AW $ TV6vk5_6WY1do ?os3q 9 70— 2119—q 1-)3
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? [3'llene ❑ Report
sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes ems%
00 1 '3'71 55-
Is this a residential or commercial project? � idential ❑ Commercial
If residential, is it; Blgingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (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 Ca'ko 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 oo f F�o mle- 51^: A 0, L-
a�
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCity ofFtCollins 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: ��5� i h J"4w Ake � Si IJ Date 9 � �' 6 II g
Print Name: Signature
Revision date 2WA17