HomeMy WebLinkAbout4912 BLUESTEM CT - APPLICATIONS - 3/27/2018PlannJA91 l3evelopnent & Transportation
ICE` U= 281 N. College Ave P.O. Box 580
}- wort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
1
OVER-THE-COUNTER PERMITS ONU.
This application is to be used to apply for the following permits a.nly (check all that apply
.ght ,I� Air Conditioning
[] "olition (intarior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0•Gas Log
C7 .1ating Unit ❑ Lawn Sprinlder ❑Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
El Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
man ufacfurer).
complete all applicable information on the application. Incomplete applications ruin not be accepted.
Application # F✓1OV09y
Fvr office use only
Sob Site 1 ddress Oq
erty,Ownee Name
,...... .. „
ApAdd
plicant Nan%_ ;
M art
Colitractor Add
Si.
Colitractor Cily of Ft. Collins SalesTax #
_.04?s'raN nuniberis raquirad by all conbactors
Is d_ s a residentiai or tor[ merdai proi
If residential, is it: �'>��S1ingle Family.
❑ Multifamily (a
if commercial, is it: ❑ 8611k b Bar
❑ Restaurant
Is this building S0 years of age or m
If this is for a demolition permit, col
If prior tzi 1975 you Pviry need an asbz
Date •� i J'/ f Z
Value of Construction (labor, materials, profit)
City/State Zip l Phone
c2-bq-- N5
City/State l Zip Phone
City/State Zip Phor z
Are you payirig taxes here or py report? ❑ Here ' *.Repor
Are you paying with your trust account? Yi es ❑ .No
❑ Commercial
o/townhome (single family attached) ❑ Duplex
], Church ❑ hotel/Motel ❑ Medical office ❑ Office ❑ Retail
7 Other (eicphln) —
7 ❑ Yes .0 No Tfye&, you may need to contact Historic Preservation
year was the.building cnristi'ucted?
s assessment to submit miM this application.
must list licensed electrician.
—
A:if lawn sprinider/backflow preventer, must list licensed plumber. IF fist -time A/C,
Su l2co ntra ctors: List ti7e company name or Oty of Ft Co/fins license
{,^r 6D�'h Plumber Mechanical Rooter Other
LlccUician_w _ � -.--
r hereby acknowledge that I have read this application and state that the above information is complete and correct I agree to
comply wwi all requirements contained herein and city ordinances and state laws regulating building construction. i know that a
hermit is not valid until it has been paid and issued.
i
Applicant:
Print Name.,_ �'G_ - Signatures