HomeMy WebLinkAbout6227 TREESTEAD CT - APPLICATIONS - 10/24/2018City of Planning, Development, & Transportation Services
=Fort Collins Community Development & Neighborhood Services
�f 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY Ll
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 ❑ M b'II H
o e ome replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA cert led, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # m q)b C1 a s4
For oA"icr use only
Date -�'o ._ 24 G8
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/Stat Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? JOiere ❑ Report
sales tax numberisrequiredbyall con bactors 673 Are you paying with your tr.Ust account? ❑ Yes <"O
Is thisa residential or commercial project? -V Residential ❑ Commercial
If residential, is it: ❑ Single 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 ❑ No If yes, you may need to contact Historic Freser✓ablon
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Iist the company name or Crty of Ft Collins license
Electrician Plumber b %� Medwnipl 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.
71
Applicant: �� /0..,24/6
Print Name: t/2t=:�% arm Signature
Date
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