HomeMy WebLinkAbout942 DRIFTWOOD DR - APPLICATIONS - 12/11/2019City of Planning, Development & Transportation
I 281 N. College Ave P.O. Box 580
For j ` Collins Fort Collins, CO 80524
' Phone 970-416-2740 Fax 224-6134
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OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Air i . ning
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo-
Vot
Ventilation Water Heater Water Line Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information,,Ion the application. Incomplete applications will not be accepted.
Application # b 1 "l ` � Iqq Date
For o>{ce use only
Jobss (required)
F
Value of ConstruCtio (labor, materials, profit)
Name Address City/State
�'rnmc�n rye l l�lLt� -1 Fc
Zip Phone
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8b5�
.30 -7C�
Applica Name Address
City/State
Zip Phone
Contractor Address City/State
I�IJL�L,iDC- PQ r_-G.ICC)
Zip Phone
02'=2j4 9
Contractor City of Ft. Collins Sales Tax #
L01 4%.9C C
Are you paying taxes here or by report? Here Qa ort
Sales tax number is required bya//contractors , + aa -y
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Are you paying with your trust account? Yes No
Is this a residential or cc r sidentia Commercial
If residential, is it: Single Family Detached Condo/townhonge (single family attached} Duplex
Multi aml y (apartment) Garage
If commercial, is it: Bank Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explain)
Is this building So years of age or more? Yes No If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with,this application.
Description of work -e 'Ile, Sll P V-enu To — /rr . ee-J-Ve
1 Vl cc IS 1 10h or1 .e rt OF
L 0U ) I bV w6 r diM
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontra ors: List the company name or city of Ft Collins license #
Electrician V 'eC_ (e 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: deriU �,sK i / �', �j�7 Print Name: l f `y Signature �� GJ' W' JC57 `���
�-, Date
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