HomeMy WebLinkAbout6315 WESTCHASE RD - APPLICATIONS - 1/29/2019City of Planning, Developments & Transportation Services
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FOrt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 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 nonstructural) ❑ Oectrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 3 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation VWaler Heater ❑ Water Line ❑ WoodlPeliet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information an the application. Incomplete applications will not be accepted.
Application # RD I ' 00 U Q 1 Date _ Ia hluary 29. 2019
Form rye only
Sob Sitr_ Address (requkW) Value of Construction (labor, materials, profit)
6315 Westcha*RdS FortCoUirw, CO 80528 $7982.00
Property Owner Name Address city/state Zip Phone
Pau7.71iayer 6315 Westd%o* *9d, FtCoU.Zn&, CO 80528 970-2I7-5331
Applicant Name Address City/State Zip Phone
C1w&WL i4wFVa U 101 S LfvtkLaaie, FtCo; CO 80524 494-7632
Contractor Address aty/stale Tipp Phone
AUevvServ% e 101 S LCr&.,Laxie FtCo; CO 80524 484-4841
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ jiere ❑ Report
Sd&-sfar mwtff &la7ffredbyat'cnrrtrac&M Are you paying with your tint account? vYes ❑ No
10010
Is this a residential or c9mmercial project? Residential ❑ Commercial
If residential, is it ` Single Family Detached ❑ Condo/bownhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical offiiee ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Yyes, you may need to conlactM&AcPreserratOn
If this is for a demolition permit, what year•was the building constructed?
Description of work 9enwv&e%4tL#1Ww/Iva4ud.rep wdlu newtr+nk1ewu)/1v
*If lawn sprinkler/baddiow preventer, must list Gomsed plumber. If first time A/C, must fist licensed electrician.
subcontractors: List the conpwynameorGtyofRCWns #
eectridw Plumbs Mechanical Roarer Other
I hereby acknowledge that I have read this application and state Mat 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.
Print Name: Cl'1.Yi�ir.YlGuEva4u signature r Date
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