HomeMy WebLinkAbout613 N BRIARWOOD RD - APPLICATIONS - 10/1/2018Fityof 7ing�, Development, & Transportation Services
Plari
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 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 # )Nlbb TO(QO l Date_ 1011 lit
For afire use only —r
Job Site Address (iequired Value of Construction (labor, materials, profit)
fD al p
Property Owner Name Address City/State Zip Phone
02
Applicant hame Address City/State Zip Phone
Z
Contractor Address City/State Zip Phone
Contractor City of Ft Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all con&actors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co�mT �ercial project? esidential ❑ Commercial
If residential, is it: aSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex I
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaf I V J1
Is this building 50 years of age or more? ❑ Yes Vo 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 Am
ern
*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 # y�`� n tn�
Electrcian Plumber Mechanical Roofed k bb 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: Signature I(7 C
Date
Revision date M2017 V ��