HomeMy WebLinkAbout4112 BEAVER CREEK DR - APPLICATIONS - 2/1/2018City of Planning, Development, & Transportation Services
Flirt 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 "ater 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 # � I V0—I'V Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
&n,, vs C (-e.-,/c Dr oO
Property Owner Name a Address City/State Zip Phone
11W&orcrielU ` For coI05 (o 946�� 976 9S6 77Y.3
Applicant Name Address City/State Zip Phone
7
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Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number esrequiredbyall conbacYws Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial prolect7 cRResidential ❑ 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 morel ❑ Yes [dNo 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 Re, rOlnce (.✓ �-r Ae -L Y�r
*If lawn spnnkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or CYty of Ft Collins license #
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: 0 / f( ^�a ICd&* L".
Prin�t Name: of Cn 6 b J�Signature (Ut!t-`— Date c� ' I — / X
Rehmon date 202017