HomeMy WebLinkAbout6244 WESTCHASE RD - APPLICATIONS - 9/9/2019Planning, Development, & Transportation Services
.Fort Collins Community Development & Neighborhood Services
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
,Ueating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line Q 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. 1 ��
Application # �M cll o b l c) DateO30.?�Z,01 !
for office use only
Job Site Address (required) hh� I� ',lNV> Value of Constr tion (labor, materials, profit)
La Q l.A �s z
Property Owner Name Address City/State Zip Phone
S rr W - CAN16 06S-AZll-iqml
Applicant Name
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Address City/State Zip Phone
530 s 525 -Z174
Contractor Address City/State Zip Phone
1 5-ao i C-4. ��14 &S -zl 57
Contrac#or ity of Ft. Colli nJ Sales Tax # j Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax nomber1sre#a1redbyancontwel rs. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 4 Residential ❑Commercial
If residential, is it: 'Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
It commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office O'Office ❑ Retail
t] Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No //yes, you may need to contact H/storic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City ofAt Collins license ,f
Electrician Piumbw Mechanical Rooter Other
l 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 issued.
Applicant:eIn % r + mm�
Print Nam. � `� ` Signature Date Z
ivia'wn date 2 O17 J U V