HomeMy WebLinkAbout4912 BLUESTEM CT - APPLICATIONS - 3/15/2018Plzinning, Development & Transportation
C r� A 281 N. College Ave P.O. Box 580
An Fort Collins, CO 60524
- Phone 970-416-2710 Fax 224-6134
t)%i EE 'a-y—E-CO LATER PERMITS ONVY
This application is to be used to apply for the following permits only (check ail that apply). ❑ Air Conditioning
❑ D -lidon (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
\, Gj 9(eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Ll EldItilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
manufacturer).
Complete all applicable informathion o((nn/ the aPP!ication, i to a elite ions will not be accepted.
AppllCation / � I IJ�L9J1
�
,4lr office use only
Site Address (required)
Owner Name, �� Address
—� Address
.AJTmcl� n�
Address
Contractor
Contractor City of R. Collins Sales Tax #
nimrb,2" & requ ?,Y by all contractors.
Income e p )
/I l J i� 0
Date — i "� 6--- -
Value of Construction (labor, materials, profit) O
City/ -State Zip w}one
`l76) '-2"tV v
City/state Zip Phone
City/State Zip ' Phone
Are you paying taxes here or by report? El Here ' .Report
Are you paying with your trust account? 'y'(Yes ❑ No
is this a residential or cg ninerdal project? -0 Residential ❑ Commerd-a
j if residential, is it: 0-single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
if commercial, is it: ❑ Bank ❑ Bar El Church ❑ Hotel/Motel ❑Medical office El office ❑ Retail
❑ Restaurant ❑ Other (explain) —'
Is this building SO years or age or morn? Oyes ❑ No If yes, you may need to contact HistodcPreservation
If this is for a demolition permit, what year was the building consb'uct'ed?
I rf pit lr to 1975, you will need an asbestos assessment to submit with this application.
Description of work
I'll' lawn: prinklerJbadcFlow preventer, must list licensed plumber. IF first-time A/C, must list licensed electrician.
S u bcontractors: List the company none or City ofR Collins license 9 Ocher
Medianical_ Roorer_._--
t here y acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply, with all iequlremcnts contained herein and city ordinances and state laws regulating building construction. i know that a
i,ermit is not valid until it has been paid and issued.
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i I
Print Name.,__ a a - Signature +'