HomeMy WebLinkAbout6315 WESTCHASE RD - APPLICATIONS - 5/30/2019an a58
City 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
1, OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply),I A4ir 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 rz�,gr\\C1
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
ltr J.oti
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
sales tax number is required by all contractors. Are you paying with your trust account? "DYes ❑ No
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Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: `I�pSingle Family Detached ❑ Condo/townhome (single family attached) [IDuplex
I�jj Multifamlly (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 Yyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of wor
*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 Acrense #
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: y,� \, 4i-r
Print Name: ��tn�� �\�%`+`I1 Signature�R�.V A` � Date,y��
Revision date 21W2017
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