HomeMy WebLinkAbout4807 LANGDALE CT - APPLICATIONS - 3/30/2018City of Planning, Development, & Transportation Services
Fort 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 ❑ Water 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 # g\00ba31Q Date
For office use only
lob Site Address (required) Value of Construction (labor, materials, profit) aQ
q901 1 CID Giti CO Boca V11-1.
Property Owner Name Address City/State Zip Phone
Sieve. �4vlf- 'I A -oA Qlbm CAO IKa� Rio 3i8 a43
Applicant Name Address City/State Zip Phone
Qawl M ! r0S-dS q -to 4gaI
Contractor Address City/State Zip Phone
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? C"Here ❑ Report
Sales tax number is requiredbyall contractors Are you paying with your trust account? ❑ Yes 9No
13013<-
Is this a residential or commercial project? dResidential ❑ Commercial
If residential, is it: ET'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 more? ❑ Yes GfNo ffyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work kPlaa D I - tihul s un 1.ip= Ccl VT •
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City 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: 'So /' I K
Print Name: t�ll'a N �`wt�Signature � __ Date r
R"NM ame 202017
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