HomeMy WebLinkAbout909 GLENWALL DR - APPLICATIONS - 4/24/2018From:
04/24/2018 05:45 0981 P.001/001
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Planning, Development, & Transportation Services
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
Vieating 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 # PD i'b 0 31 a a Date _ 4,.gyd
For o>i9re use only
Job Site Address (required) Value of Construction (labor, materials, profit)
1 qy
Property Owner Name Address City/State Zip Phone
Tay
Applicant Name Address City/State Zip Phone
Contractor Address Clty/State Zip Phone
Contractor City of Ft. tins Sales Tax # Are you paying taxes here or by report? I$Mere ❑ Report
safs'taarnnnd berIsmq&f bya(Icnnbacmrs Are you paying with your trust account? pPyes ❑ No
Is this a residential or commercial project? 80esidential ❑ Commercial
If residential, is it: Ingle 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 So years of age or more? O Yes O 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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or C7ty Of CoU/ns license 0
Electrician Plumber Medwnical 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: Print —
Print Name:� akt?�`tt% Signature 0&p,blkl9 Date �.
Rwidon date 20=17