HomeMy WebLinkAbout6569 FINCH CT - APPLICATIONS - 1/6/2020City of Ae Planning, Development, & Transportation Services
F6rt 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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation VLWater 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 # , J o C) ` I - Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
or ( s boo - s - 12 It 1 31
Property Owner Name Address City/State Zip Phone
Tr Carr - V l9S 1_1r r-.4 60 l,„ Co 5-7,¢- 0/1
Annlicant Name 7A—ddress City/State 8052, Jr Zip Phone
Contractor Address City/State Zip 10526 Phone q7o -
Ben iatnM Franelin blizinbinqoo —In-nova. 'in Dr. 150iK ZQZ 3 -M
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here -or by report? ❑ Here &eport
sales tax number is required by allcon&acmrs Are you paying with your trust account? Ayes Iff No
�m 31
Is this a residential or commercial project? & Residential ❑ Commercial
If residential, is it: ® 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 Ig No If yes, you may need to contact HistoricPreservabbn
If this is for a demolition permit, what year was the building constructed?
Description of work 1 1: I I i,,A h r L I e_r in, �yr,j9 r- c Y O k [ire)
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCdyofFtCollins license #
Electrician Plumber," P 5qS 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:
Print Name �2YC"I"6 Signature _ Date
Revision dale 21612017