HomeMy WebLinkAbout4425 VIEWPOINT CT - APPLICATIONS - 11/13/2018a�qc�
FCity of Planning, Development, & Transportation Services
ort Collins Community Development s Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970A16.2740 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 appy ab eTrionon the application. Incomplete applications will not be accepted.
Application # Date 11 1-8\�
for ofte cone only
lob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Tip Phone
Contractor Address Gty/State Zip Phone
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? $Diere ❑ Report
Saks tarnrnnba'li;regL*Wbyallmnbacicvs. Are you paying with your trust account? )Pies ❑ No
3Z�s
Is this a residential or commercial project? i&sidential ❑ Commercial
If residential, is It: VhSingle Family Detadled ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If mmmercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No ff yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work"-Za 6SI t t M1Ps
*If lawn sprinkler/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or City of Ft Collins Ncrnse 0
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
Print Name: V\ e%A aZ �`oe� Signature �kk 6A� Date
Revision ate 2AM17
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