HomeMy WebLinkAbout4132 CENTER GATE CT - APPLICATIONS - 6/26/2019:.I ,::; Planning, Development, & Transportation Services
F& C®«II�s 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 # �) 1664%�
For office use only
Date— 09&bg
Job Site Address (required) Value of Construction (labor, materials, profit)
,-'4/3:) G_,+er G&J'&_ 0'+. $ 5713. CC
Property Owner Name Address City/State Zip Phone
cud i I ei C �r :✓�-5 $��o Q O- i
Applicant Name Address City/State ZipPhone
C 1 LNknd60537 01 ►D, -1-10
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sa s Tax # Are you paying taxes here or by report? Here ❑ Report
Sales tax number is required by all contractors, Are you paying with your trust account? )KYes ❑ No
44i®L41
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? ❑ YesVNo 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
1 C(ass 10
*If lawn sprinkler/backflow p eventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # `y,
Electrician Plumber Mechanical Roofer K ` 1'"'tOW 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:_ s4%kA- tePa fVA Signature Date (.o%a(n f 19
Revision date 2/612017