HomeMy WebLinkAbout6944 BARBUDA DR - APPLICATIONS - 7/23/2019City 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 VBoofing ❑ 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 # bi gwi ZC) Date -I �d_
For office use only
Job Site Address (required) Val of co truction r, materials, proflt)
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Property Owner Name Address City/State Zip Phone
dot bu." or ! (�' _
Applicant Name Address City/State Zip Phone
Contr r Address City/State Zip Phone
Contractor City I Ft. Collins Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
sa,(eftaxnnuummber& equi^ed�¢yallrontractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential) or commercial project? OResidential ❑ Commercial
If residential, is it: g4ehgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage ) f ns�
If commercial, is it: ❑ Bank El Bar ❑ Church ❑ Hotel/Motel ❑ Medical office El Office ❑ Retail (�1J1
❑ Restaurant ❑ Other (explain) R
Is this building 50 years of age or more? ❑ YesMlo If yes, you may need to contact Historic Preservation �
If this is for a demolition permit, what year was the building constructed?
Descripti n of work a swr--� 0k pai
*If lawn sprin evr/bac ow preventer, must list licensed plumber. If first-t a A/ , 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: / w ��,CC � �A®� �j(
Print Nam: �� CVS ignatu 1 ate e91
Revision date ZW O17 \/
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