HomeMy WebLinkAbout613 MEADOW RUN DR - APPLICATIONS - 12/19/2018 (2)Dec 19 2018 08:38AM HP Fax page 1
TIYase—
.� Planning, Development & Transporiatlon
JJ 281 N. College Ave P.O. Box SW
7"Fort Collins, CO 80524
d Y 1L ( Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This 8PPI1081ion is to be used to apply for the following permits only (check all that apply). M(Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter 13 Gas Log
9-Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo-vottelc
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application #1661 CM5/ff. q,10°f4C5 'Date tZ -)g-Is
Aw ofte use o*
Jobtm-40
Ad ress lrequtred) Value Of Construction (labor, maberlalp, profit))
4-dowur> )fir. 1 $ --I-) � n � � �0
Property Owner
Name Address
City/State
Zip
Phone
5 f;a Froe) i ch sa,.,_
Ge.
Applicant Na
ie Address
City/State
Zap
Phone
Contractor
LJc # Address
ClWState
Zip
Phone
rn�rfeafr �/r'
� #-! 7AI 5(e (E �'�td�n �jr. #� W,ne(tvr C'D-
6095o
97v 6*&-40Flp
Contractor Cit
y of Ft Collins Sates Tax
'3 �'3y�
Are you paying to m here or by report? ere 0 Report
Sift td`d
bl'd/m+traciarF,
Are you paying with your mist
account?
Yes No
Is this a reside ntial or cojnmercial project? VResklential 0 Commercial
If residential, Is It: 10 Single Family Detached p Condo/trnwthome (single family attached) ❑ Duplex
E3 Multifamily (apartment) O Garage
IPcommercial, Is it: 13 Bank E3 Bar E3 Church 13 Ho4sictei 13 Medical office E3 Office ❑ Rail
0 Restaurant 13 Other (explain)
Is this builds 50 years of age or more? O Yes MINo Dyes, you may need to aavbct HNor/c plawrmf rwi
If this Is for a emoI tlon permit, what year was the building constructed?IfpHor to 19 , yrw tvl// naiad an aowstnts assessrAwt to submit wAri h* app/lodlon.
Desaiption Of work Ke ok c*-
*If lawn /baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subs Lstthe =pwynameorQyofRColins&-e it
Plumber. Medenkal Roofer Other
I hereby ackno Nledge that I have read this application and slate 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 its not valid untD It has been paid and issued.
Applicaft
PrintName: Signature Date �Z — f c} —)B