HomeMy WebLinkAbout6126 WESTCHASE RD - APPLICATIONS - 11/14/201811/13/2018 13:32
Page 1/1
Cityttf Planning, Development, & Transportation Services
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 # ) o Q g W co Date
For ofrtce use only
Job Site Address (required) Value of Construction gabor, materials, profit)
$ 14560
Property Owner Name Address City/State Zip Phone
col ins
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone tc
62 I.l.Mh, -�' `cam um Mtk V1 4L-0 sil� I of ca)IlIr s
Con actor City of Ft Collin Sales Tax # Are you paying taxes here or by report? )KHere ❑ Report
WagtBXnumberisr uiredb alirontradon;. Are you paying with your trust account? )RYes ❑ No
ti 19a�
Is this a residential or commercial project? ,(Residential ❑ Commercial
If residential, is it: I<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^ If yes, you may need to contact Histonc Preservation
If this Is for a demolition permit, what year was the building constructed?
Description of work Rp lace. 5SO q c4A t D D aris,
WaAcr h
*If lawn sprinlder/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontractors: List the company name or City of Fr Collinsllcense #
r
Electrician Plumber 1 I tP r1 ��_ 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: I11'LI SSCt LLI +CY Signature _
Print Name:_ 1. Si nature Date _
Revision dale 27 017
-70)