HomeMy WebLinkAbout633 W COY DR - PERMITS - 10/7/2019 (2)Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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. Incomplete applications will not be accepted.
Application # bll 13 J1fl
For office use only
Date 7- /9
Job Site Address (required)
3 3 1rr/�s�
Co
Value of Construction (labor, materials, profit)
V W, ?eo 00
Prop�jrty Owner Name
65
Address
City/State
Zip Phone
VAppicant Name Address City/State
Zip Phone
Con actor
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Address
City/State
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Zip Phone
Co. 905-3I 117 57'V
Aob4ctor City of Ft. Col ins ales Tax #
Are you paying taxes here or by report? ;0 Here ❑ Report
Sales tax number is required by all contactors.
Db lyoz ll
Are you paying with your
trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: 0 Single 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? ❑ Yes VTNo If yes, you may need to contact Historic Preservadon
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 of Ft Collins license #
Electrician Plumber Mechanical -Al6 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: / / � Print Name: 11 G G SignaturJ1111v'y6401Date /� �✓ �/