HomeMy WebLinkAbout925 VANDERBILT CT - APPLICATIONS - 2/14/2019City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
qV�"\ 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 # f1� --�I q �`3� Date
All nffn tK& on/v
Job Site Address (requlred) Value of Construction (labor, materials, profit)
Ci lt9 _P- CT
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
G u'b o Ei Jsa 6 53 P _ S 6DL .5 (yi 4v. 1- - roa r aiS 23 qr;2�-sg-7a -201 0 06a
Contractor /� va Address` City/State Zip Phone
02Y l_.�U-�.�5 l�hS'fnyLR'Ttc�wJ S;A-m
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? W Here ❑ Report
saresraxnumber isregqulmloyallronvac vs Are you paying with your trust account? pLYes ❑ No
Is this a residential or commercial project? WResidential ❑ Commercial
If residential, is it: iJ Single Family Detached ❑ Condo/tewnhome (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 t4No If yes, you may need to Contact H/storic Pfeservatinn
If this is for a demolition permit, what year was the building constructed?
Description of work ✓t AN n apene S4R WA�Gi 6F P N.11Ge S s
l r 75 Gn /! .0 i roY , S
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or G'ty of Ft Co//ins license 9
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 Lssued.
Applicant: '�^
Print Name; e- J .SO Signature Date _
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