HomeMy WebLinkAbout931 FOSSIL CREEK PKWY - APPLICATIONS - 5/3/2019City 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 #
For"o#ke use only
Date 5-3— 157
d
lob Site Address (required) Value of Construction (labor, materials, profit)
66�c')
,73 fq-5s,'1 60 -2 - o- ss- g
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
C4p� i 'erg logo w ! h to co o rq ?Aa-68s"-�S0
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
Sales tax number isrequiredbyall contractom Are you paying with your trust account? ❑ Yes ,IE' No
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: N 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 SO years of age or more? ❑ Yes g No ffyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work X ,51 rrPews'-�1 L, 4� s ir, l,` ✓, n� r^., (EX:si n4
o be &i4eco
P%c'a 7Le a Lave -Z O& 11 acie QbG/bY 2 r
*If lawn sprinkler/backflow preventer, must list licensed plumber. It 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: 3 /%
Print Name: % f %Lz' Date Signature �.—`
Revision date 2/6/2017