HomeMy WebLinkAbout6714 ANTIGUA DR - APPLICATIONS - 6/25/2018FCity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins CO 8=4 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) 0 Air Conddwnmg
❑ Demol'fion (interior non-structural) 13 Electrical Alteration (not service charge) D Gas Lighter 13 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler El Mobile Home replacement 13 Roofing D Sewer Line ❑ Photo-vottax
❑ Ventilation t;ANater 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 * Q) 190 y Hqt (Q
For office we arty
Date b�o
]ob Site Address (reprxried) Value of Construction (labor, materials, profit)
KIM -4 i # LlU � 1 Mtn � �-S 15r l�o
Property Owner Na Address city/ate Zip Phone
v -TtA 46Ps ale br., fir+G01<<Vi C�
Applicant Name Addiess city/state Tip Phone
Fort Collins Heating $ Air 208 Commence Dr #4 Fort Collins, CO 80524 970 484 4552
Contractor Address City/state Zip Phone
Fort Collins Heath & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970 484 4552
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? 0 Here Wepoit
Sa "'Lffnbff 'fina#=b3dPMAre you paying vntti your bust account? Yes 0 No
Is this a residential or Resilendal ❑ Cowl
If residential, Is it: f9nVg:1WeF2arr:v1AY= Cmdo/townhome (single familyattached) ❑ Dupbcly (apartment) O Garage
If comrneraal, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office 0 Retail
17 Restaurant ❑ Other (explain)
Is this building SO years of age or more? 17 Yes ❑ No if ye4 kvu may need to cartact H&tmx preervabon
If this is for a demolition permit, what year was the building construc ted7
Descri on of hnro r
*If lawn sprinkler/baddlow pxevester, must list lia seed plumioer If first-ttime A%C, must Itst fuelled dectrican
Subcontildctom List the maWany name or (31yofR CoNins idaar w #
i Mexlianiiri H1�` Rwfer Other
I hereby adnOwWW that I have read this Vphcation and state that the above inbuiatkm is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building corilructon I know that a
Permit Is nut valid until it has been paid and Issued
Applicants �J
Print Name Signature pate �Vl
Revision date 2WA17
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