HomeMy WebLinkAbout2028 EVERGREEN DR - APPLICATIONS - 3/14/201802/27/2018 5 11PM FAX 870352,7088 ACLEANSWEEP IM0001/0001
"trot Callins
Planning, Development & Transportation
281 N. College Ave P.O, Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that a 1 ❑ Air Conditions g
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) M Gas Lighter 0 Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line 13photo-voftaic
❑ Ventilation O Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be SPA certified, provide make, model and
manufacturer)
Complete all applicable Information on the application. Incomplete applications will not be accepted. 1
Application #� �p I �v°� Date B- // �f I XL1
�only
Job site Address /reouired) Value of Construction (labor, materials, profit)
J
Property Owner Name Address v city/ate Zip Phone
J4 ni es 4-)Van-4plse01 '5-;28 96 f a -y!4
Applicant Name Address City/State
Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here Jr by report? 0 Here
saes raxmHr, ulrPd byallcatracror� Are you paying with your trust account? ❑ Yes #01
Is this a residential or Commercial project? 411"Idential Q Commercial
If residential, is it: Single Family Detached 13 Condo/townhome (single family attached) 0 Duplex
13 Multlfamily�(apartment) 17 Garage
If commercial, Is It: Q Bank ❑ Bar ❑ Church Q Hotel/Motel ❑ Medical office Q Of� ❑ Retail
0 Restaurant 17 Other (explain)
Is this building 80 years of age or more? M Yes ci No If0s, YOU may need to contact HWo1Yc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you w/// need an asbestos asse,wment to subm/t with this app/icatlorz
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber, if Hrst-time A/C, must I1st licensed electrician.
Subcontractors, L/st the company name ar G"ity of ft Co//Ins //tense'o
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
ree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that
permit is not valid until it has been paid and issued.
Applicant: e-a krrj �
Print Name:_ 'Signature
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