HomeMy WebLinkAbout1422 WILDWOOD RD - APPLICATIONS - 7/3/2018FCitycif 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). O Air 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 appi bls I formation on the application.
Application #
For office use only
Incomplete applications will not be accepted.
-IDate �� r l V
Job Sitel Address (required) Value of Construction (labor, materials, profit)
W I lU
Property Owner Name Address City/State Zip Phone
1 -
Applicant Name Address City/State Zip Phone
0 `b
Contractor Address City/St to Zip Phone
Contractor City of Ft. Collin§Sl3les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sales raxnumber &mquiredbyall mn&wtors rz�(I D Are you paying with your trust account? ■ Yes ❑ No
Is this a residential or commercial project? N Residential ❑ 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 ❑ 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/backfiow 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 0
Electrician Plumber Mechanical-M 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 constructlon. I know that a
permit is not valid until it has been paid and Issued.
Applicant: l(�� I C '
m
Print Name:`J W... � U m Signature Date m
Revisim date 2fn017