HomeMy WebLinkAbout839 CAMPFIRE DR - APPLICATIONS - 10/26/2018�City of Planning, Development, & Transportation Services
�t 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 5a oofing ❑ 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 # P)ncnl � Date �(717i(Q Ij8
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
WUOS, CD Asa c� 00D
Property Owner Name
Address Gty/ to Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
Contractor City of Ft Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Was taxnumber&rwuiredbyaiiconbacmrs. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or comm�ercial project? esidentiai ❑ Commercial a
If is it: (Single
residential, Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage Sh
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office j❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes @'No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work -w
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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 orCtyofFtCollins license #
Electrician Plumber Mechanical Roofer kOther
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 Q'#C
Name: Signature Date ll G
Revision date 2WO17 v