HomeMy WebLinkAbout901 DEERHURST CIR - APPLICATIONS - 3/17/2017MAR/17/2017/FRI 03:15 PM
FAX No. P. 006
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
❑ 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.
Application # I `71
For office use only
Incomplete applications will not be accepted.
Date ', - I—) • I I
Job Site Address (required) Value of Construction (labor, mat rials, profit)
L90(U�,10iL iEd p o(+- ColIios Co �OD<
Property Owner Name Address Gty/State Zip Phone
i2 K Same. as a bu\r-e,
Applcant Name n Address City/State Zip Phone
Contractor Address City/State Rd Zip Phone
--- - -. . A - ' - - -
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sa/eslaw number isrnqu/redbyal/can&acmrs Are you paying with your trust account? ❑ Yes ❑ No
y (okatp
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 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 IY75, you wi//need an asbestos assessment to submit with bh/s application.
Description of work Rf 2 irl
a +er
*If lawn sprInlder/backflow preventer, must list licensed plumber. If Flrst-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license At
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:
Print Name:—Ka1110 Signature Date f