HomeMy WebLinkAbout931 WAGONWHEEL DR - APPLICATIONS - 10/1/2018CACityoff Planning, Development, & Transportation Services
,art Collins Community Development $ Neighborhood Services
281 North College Avenue \ i�
Fort Collins, CO 80524 Main: 970.4162740 Fax: 970.224.61 lJ
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 tighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 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.
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Application # ) �3 � Date
For office aw on*
Job Site Address (raqwvd) Vr Value of Construction (labor, maberials, profit) .
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Property dwner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address bty/State Zip Phone
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Contractor City of FL Copt' Sales T # Are you paying taxes here or by report? Here ❑ Report
Sa/ertax numberis; neqmedbyall m Are you paying with your trust account! es ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it ❑ Single Family ❑ Condo/toamhome (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 yearsof age or more? ❑ Yes ❑ No Iff yes, you may need to corr&xt HaYwic Preservation
If this is for a demolition permit, what year was the building eonstrucbed?
Description of work t a'
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6S 'C3� 006 8711
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If firs"me A/C, must list licensed electrician.
Subcontractors: List the aompiany name or Qy of CoMw /ice g
Oectridan Plumber Medianiral RoderOther
I hereby admowledge 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 'I it has been paid and issued
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Applicant: �Cl/1UhU1'll�atii� '
Print Name: Sate I �'
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