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HomeMy WebLinkAbout3858 CENTURY DR - APPLICATIONS - 2/26/2019 (2)City of Planning, Development, & Transportation Services Fort WlinS Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 80524 Main: 970.4162740 Fax 970224.6134 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-shvctural) ❑ 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 ❑ Wooffellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # V I � ©I ) � Date February 26, 2019 For affix rm a* Job Sidhe Address (required) Value of Construction (labor, materials, profit) 3858 Centry Drive, Fort Collins, CO 80526 $5750.00 Property Owner Name Address Crty/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 aty/State %pp Phone Allen Service 1015 Link Lane Ft Co, CO' 80524 484-4841 Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? ❑pere ❑ Report . /es tit rnumber1sn4z&adbya9mrtmc&& Are you paying with your trust account? ' Yes ❑ No 10010 Is this a residential or 7, nmeraal project? irResidential ❑ Commercial If residential, is it 1Z Single Family Detached ❑ Gando/townhome (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 lfpes,ywn?ayneedtocont3dif5tm*Amswvabhr7 If this is for a demolition permit, what year was the building mnAructed? Description of work l eK "istG mil and r glme w th like new mil *If lawn sprinlder/backtbw preventer, must list licensed plumber. If first-time A/C, must Ilst licensed electrician. Subcontractors: List the campanyname orGryofFtCaNnsNcerese 0 F3eatrioan Plumber Mechanical Roofer Other I hereby advwwledge that I have read this appGmtion and state that the above information is complete and correct I agree in comply with all requirements contained hereln and city ordinances and state laws reguMng building construction. I know that a permit is not valid urrtrl it has been paid and issued. riC �v PnName: signature( _ &in n D4z-(,71 iv FWAsI minaem7