HomeMy WebLinkAbout3858 CENTURY DR - APPLICATIONS - 2/26/2019City of Planning, Developments & Transportation Services
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 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 ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #?-�) ( q () / / 7
For office Ize only
Date February 26, 2019
Sob Sibe Address (requchaV Value of Construction (labor, materials, profit)
3858 Centry Drive, Fort Collins, CO 80526 $6544.00
Property Owner Name Address City/State ZIP Phone
Paul Thayer 3858 Centry Dr Ft Collins,CO 80526 970-420-7789
Applicant Name Address City/State Zipp Phone
Christina Evans 1015 Link Lane Ft Co, CO 80524 494-7632
Contractor Address City/Slate ZiPP Phone
Allen Service 1015 Link Lane Ft Co, CO 805Z4 484-4841
Contractor ClIty of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ ere ❑ Report
�tvxnamberfsnv�bya9maliacmrs Are you paying with your tnist account? Yes ❑ No
10010
Is this a residential or Wrnmercial project? Residential ❑ Commercial
If residential, is it `-4 single Family Detached ❑ Condo/tawnhome (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 ❑ No Y^ you mayneed to av7t?ctHiFbricPravrrabon
If this is for a demolition permit, what year was the building constructed?
Description of work Remove rxisti.g fi`"°" °"°'" """' like new furnace
r
*If lawn sprinlder/bac:Mbw preventer, must list licensed plumber. if first-time A/C, must fist licensed electrician.
Subcontractors- List the oxWny name or Lily offt Collins how se &
Electrician plumber Mechanical Roofer Other
I hereby acknowledge that 1 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 consbruction. I know that a
permit is rut valid until it has been paid and issued.
Appl
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