HomeMy WebLinkAbout631 MEADOW RUN DR - APPLICATIONS - 5/1/2018= Planning, Development & Transportation
City of 281 N. College Ave . P.O. Box 580 -
Fort Collins �- �'� u. '�.u� ;
�' -�'�; - � - �-Fort Collins, CO 80524
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/r�� Phone 970-416-2740 Fax 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) ❑ Gas7Lighter ❑ 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 applicablq information on the application. Incomplete applications wilt not be accepted
- Application # Dat'L
For office use only .
. 9
Job Site Address (required)
Value of Construction 1(labor, materials, profit)
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Property Owner Name
Address City/State = Zip
Phone
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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 or by report? ❑ Here
❑ Report
Sales tax number is required by allmntractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? ,Residential ❑ Commercial
If residential, is it: .r 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)., jl
Is this budding 50 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 budding constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work _
2 Su
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber - Mechanical Roofer
1 hereby acknowledge that I have read this application and state that the above information is compli
comply with all requirements contained herein and city ordinances and state laws regulating budding
permit is not valid until it has been paid and issued.
Applicant:
Print Name: ��P'i(�*� Signature
electrician.
Other
ate and correct. I agree to
construction. I know that a
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