HomeMy WebLinkAbout3858 CENTURY DR - APPLICATIONS - 2/26/2019 (3)City of Planning, Development, & 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 perms only (check all that apply). ❑ Air Conditioning
Cl Demolition Cinterior nonstructural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas tog
❑ Heating Unit JI Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voHaic
❑ VentilationIffWater Heater ❑ Water Line ❑ Wool llet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application * UIy 1 �'
Foroflue ave only
Date _February 26, 2019
Job Site Address (requbel Value of ConsbuCtion (labor, materials, profit)
3858 Centry Drive, Fort Collins, CO 80526 $1750.00
Property Owner Name Address City/Stake Zip Phone
Paul Thayer 3858 Centry Dr Ft Collins,CO 80526 970-420-7789
Applicant Name Address City/State zip Pion
Christina Evans 1015 Link Lane Ft Co, CO 80524 494-7632
Contractor Address City/State Ap Phone
Allen Service 101 5 Link Lane Ft Co, CO 80524 484-484I
C lontracinr City of FL Collins Sales Tax 1f Are you paying taxes here or by report? [],Pere ❑ Report
-Wes tarmenber&rsndiedbyadcwhvrfam Are you paying with your trust account? IYYes ❑ No
10010
Is this a residential or qpirnmercial project? Re clential ❑ Commercial
If residential, is ii: 'S�J Single Family Detached ❑ Condo/bownhome (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 Yves, you mayneed to conla&ifttoricPresnrnd8bn
If this is for a demolition permit, what year was the building constructed?
Description of work Rr a existing w/h and replace with like new w/h
*If lawn sprinlder/baddimv preventer, must list licensed plumber. If first-time A/C, roust list licensed electrician.
Subcontractors: List Me carnpanyname or City al r2llr &ffilse #
F? iciati Plumber Medlankat 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 bugling construction. I know that a
permit is not valid untl it has been paid and issued. / ' n n,iJ.1l/dbn(
Print Name: ClwiatittwCvav�aSignature l 11 V l,iida-L9Dabe �-
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