HomeMy WebLinkAbout6107 PARAGON CT - APPLICATIONS - 7/26/2019City, of Planning, Development, & Transportation Services
Fart 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 f 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 # Em ) s-g(03 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
loplo-1C-k 5;nr-A CoWics SC62S2"Sly 2Z L• lt
Property Owner Name Address City/State Zip Phone
101 &0a 0 CA 9052 7 n30Q_'t
Applicant Name Address City/State Zip Phone
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50L% \Rd LgQ*c 710f W-W
W`e_`Q L9
Contractor Address City/State Zip Phone
In a Leas Su 4 ?0-Y184-7
Contractor City of Ft. Collins Sales 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? ❑ Yes ❑ No
Is this a residential or commercial project? 10 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? ❑ Yes OONo 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 — J,Z- 0.--\ Q
CA
*If lawn sprinkler/backflow preventer, must list licensed plumb . If first-time A/C, m st 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:
Print Name: Y `a `�`�"`a Signature Date 7- 2(A9
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Revision date 21612017