HomeMy WebLinkAbout423 RIDDLE DR - APPLICATIONS - 10/1/2019City f Planning, Development & Transportation
�y O281 N. College Ave P.O. Box 580
01rt Collins Fort Collins, CO 80524
/ Phone 970-416-2740 Fax 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove
(must be EPA certified, provide make, model and manufacturer).
Complete all applicable information on the application.
Application #
For oftce use only
Incomplete applications will not be accepted.
Date 16 � �
lob/ Site Address (rregouirjed)
Value of Construction (labor, materials, profit)
?
- 2 (r
�xC////'
/
li g/
J ' , of at r
o_
C Jri/2
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Contractor City of R. Collins Sales Tax
#
Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number is required by all contactors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? L&1esidential ❑ Commercial
If residential, is it: .Dingle Family Detached ❑ Condo/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? jU Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
of work
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
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 issued.
Applicant, �/J
Print Name:�e va , el �,. c .cF L4 Signature Date �� /