HomeMy WebLinkAbout6802 ANTIGUA DR - APPLICATIONS - 3/3/2020F&City of Planning, Development & Transportation
t Collins 281 N. College Ave P.O. Box 580
�"e.�- 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
❑ 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 . 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 #
ForoAice use only
]cab Site Addres ( uiredj
m�1��
Pr, vty Owner Name Address
Applicant Name
Contractor
Contractor City of Ft.
Address
01 lad
Tax #
Sales tar number is m jW E all n&actom
Address
Date
Value of Cc
struction (labor, materials,
City/state Zip Phone
kAM,MO zl)I-r�15-
City/State Zip Phone
City/State Zip Phone
YJ Lbvrt U c6 37 moo-ioar,&o
Are you paying taxes here or by report? ❑ Here Rel
Are you paying with your trust aocoui 7 X 9 No
Is this a residential or commercial project? Resl ential ❑ Commercial
If residential, is it: ❑ Single Family Deta ed ,�ondo/townhome (single family attached) ❑ Duplex
If commercial, is it: ❑ Bank Multifamily ❑ Bar ❑ Church ❑ H el Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (expia )
Is this building 50 years of age or more? ❑ Yes o If yes, you mayneed to aonlact Historic PfWfyadon
If this is for a demolition permit, what year was building constructed?
Ifprior to 1975, you will needan asbestos assessment to submit with thisapplicalron.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed elec b.idan.
subcontractors: L1st the company name or OZy offt Collins license #
ElecVdan Plumber - 5a4 Mechanical
Roofer. Other
I hereby adcnowledge 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: ��UroPrint Name �p„tom 11
�Jl/i bi Signature , A
Date
U�