HomeMy WebLinkAbout612 POWDERHORN DR - APPLICATIONS - 5/10/2018City 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) Nar 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 #_ f514034%(p Date
For office use only
)ob Site Addr(s (required) Value of Construction (labor, materials, profit)
LP �� bWA-e rhos r . JZ000
Property Owner Name Address City/State Zip P_ione
Applicant Wiln Address City/State Zip Phone 9-7D
Contractod Address City/State Zip Phone 4�-7b
S L JZ 3 ., Pvr d OS-3 /9-/&7
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 19 Here ❑ Report
Sal, tax er requiredbyall contractors. Are you paying with your trust account? ❑ Yes Al No
Is this a residential or commercial project? kResidential ❑ Commercial
If residential, is it: 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 M No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year wa' the building constructed?
Description of work (,AadLAI&, 'n hre Lk� l7�
*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: �L" "" c—
Print Name: rJ U t ��rw�, Signature.J Date �— /0 / f
Revision date 2/6/2017