HomeMy WebLinkAbout6227 WESTCHASE RD - APPLICATIONS - 4/8/2019City of Planning, Development, & 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 ❑ 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 # Date ZI-8—" q
For ofce use only
]ob Site Address (required) Value of Construction (labor, materials, profit)
�27 tL(/f5re. h 7 7- ou CC $Gt1- �7I z
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
Qsvu2 fie.,-1 )RA JC-A?a1-,J7 /so!,o-canF,../ crAzo F2r6L&i -s e0 8-oreV 970-797-2760
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by allcon"dom Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? kesidential ❑ Commercial
If residential, is it: At-5ingle 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 SD years of age or more? ❑ Yes t] 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 ?� oy= enaplGrt_ %�60F M h6zAv.y • lnuV!�cr hrc ovaan lam,.— /rs1W
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*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 Zv/✓nZ 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: .v Signature Date
Revision dale 2W017