HomeMy WebLinkAbout6714 AUTUMN RIDGE DR - APPLICATIONS - 6/6/2018FCity of Planning, Development, & Transportation Services
ort 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) 1plkir Conditioning
❑ Demolition (interior non-structural) ❑ 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 # F7 � lb 0 yt.4 b-1 Date k\ss a
For ofte use only
lob Site Address (required) Value of Construction labor, materials, profit)
JA
Property Owner Name Address City/State Zip Phone M I
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? $3iere ❑ Report
Sales tax number is required by all conbactors Are you paying with your trust account) VPYes ❑ No
Is this a residential or commercial project? EtOesidential ❑ Commercial
If residential, is it Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 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 morel ❑ Yes ❑ No If yes, you may need to contact H151onc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of wor
*If lawn spnnkler/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electncian
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 budding construction I know that a
permit is not valid until it has been paid and issued
Applicant `
Print Name l'ta;h��i\`lri Signature ��4N Date \` g
Revision date 2JW2017
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