HomeMy WebLinkAbout1422 WILDWOOD RD - APPLICATIONS - 7/3/2018 (5)Cityof Planning, Development, 6 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) ❑ 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 ❑ WoodlP
manufacturer).
Complete all appl ble formation on the application
Application # G�
For ofte use only
ellet Stove (must be EPA certified, provide make, model and
Incomplete applications will notbeaccepted.
Date � -� 1 0
.Job Site Address (required) Value of Construction (labor, materials, profit)
-Ptopeq Owner Name Address C City/State ZIP Phone
Applicant Name Address City/State Zip Phone
xil 1C� r Q ,
Contractor Address City/S to Zip Phone
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Contractor City of Ft. Collin§lles Tax # Are you paying taxes here or by report? ❑ Here ■ Report
sie'ftxnumber Isrequlredbyal/car"am, r1 tAre you paying with your trust account? N Yes ❑ No
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Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: ■ Single Family Detached ❑ Condc/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/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the rromperryname or Oty of Ft Collins license 0
Electrician Plumber Mechanical_aw t Roofs 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. p
Applicant: U m l�
Print Name; C,Y 1" Signature Date
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