HomeMy WebLinkAbout6008 NEPTUNE DR - APPLICATIONS - 3/1/2018Mar 01 2018 11:22PM HP Fax 9706130826
page 1
Planning, Development, & Transportation Services
: Fort COUIns Community Development & Neighborhood Services
281 North College Avenue
Fora Collins, CO 80624 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 Lightef❑ Gas Log
�Q Heating Unit ❑ Lawn Sprinkler 0 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 informatio on the application.
Application # 1y
For only
Incomplete applications will not be accepted.
Date_,3,1Q19
Job Site Address (required) JF Value of Construction (lalwr, materials, profi
0-2
Property Owner Name Address City/State ZIP Phone
e s
Appbi t Name Address City/State Zlp Phone
Contractor Address City/State ZIP Phone
Contractor City of R. 611ins Sales Tax # Are you paying taxes here or by report? Q Here ❑ Report
Sales laxnumberls mquhedbyallmntractom Are you paying w'dh your trust account? �) Yes ❑ No
Is this a residential or commercial project? V Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/bownhome (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?
Description of work n1vonf-e (Ind WC., QDID(
gl070 1 MI ODO C33td low a +UKi
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time AJC, must list licensed eleetridan.
Subcontractors: L& the company name or City of ft Co1Nns Naense #
Electrician Plumber Mechanical Roofer Other
I hereby admowledge 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.
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Print Name: �« Ll�+tt1 Ina Date 3 � I���
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