HomeMy WebLinkAbout908 LANGDALE DR - APPLICATIONS - 7/27/2018 (2)Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins. CO 80524 Main: 970.4162740 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)y°�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 applicable information on the application. Incomplete applications will not be accepted.
Application # BIgo (of j� Date
For office use only
lob Site Address (required) Value of Construction (labor, materials, profit)
�, CIAX/ dw I C /- s 5 y/3 ?
Property Owner Name Address City/State Zip Phone
rle' 5D6 Zuni c%/_ 17_ 93/ - t$5 5/3
Applicant Name Address City/State Zip Phone
611,skl 9Dl D - / 905- j6C- /3
Contractor Address City/State Zip Phone
5F4i�.,
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Sere ❑ Report
saiestax number isrequired byall contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ 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? ❑ YesAWNo 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 ?0f '3GF :!�q
*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: //��
Print Name: /wA/ d l-i1S1," Signature Date �17
Revision date 2B/1017 / / /