HomeMy WebLinkAbout4318 MILL CREEK CT - APPLICATIONS - 7/25/2019City 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 # I t%/ D0 q -7
For office use only
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
fir' fi �-I'h dHt5- I7D- 3-
Applicant Name Address City/State Zip Phone
a e e 17D-3-�
C ntractor Address City/State Zip Phone
k G S `"
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? XHere ❑ Report
Sales axnumber isrequired byall con&actors. Are you paying with your trust account? El Yes No
Is this a residential or c mmercial project? Residential ❑ Commercial
If residential, is it: Single Family Detac6ell ❑ 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? ❑ YesNo Ifyes, you mayneed to contact Historicva Presertion
If this is for a demolition permit, what year was ccbuilding constructed?
Description of work C V�- J — fZ C f Z et✓
*If lawn sprinkibackfiow preventer, must list licensed plumber. rst-time A/C, must list licensed el"eian.
Subcontractors; List the company name T
City of Ft Collins license # v
Electrician aPlumber Mechanical Roofer d d� 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: Signatu Date
N
I F?16
Revision date 2/612017