HomeMy WebLinkAbout948 SHIRE CT - APPLICATIONS - 8/2/2019�195g1
City of Planning, Development, & Transportation Services
F®rt 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� lQ`►1 -I Date Ia\n
For office use only
lob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
S C C&• �tVQ 6% lkaaj
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Co tins Sales Tax # Are you paying taxes here or by report? 03iere ❑ Report
sales- ltax �number isrequired byall mnbactom Are you paying with your trust account? FPfes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: '193ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Lf 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 ❑ No 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 :y=Ca,1TS Q a
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or G'ly of Ft Collins license #
Electricfan� 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: \ �`r+n� 1
Print Name:�-D 71�tn�@ a;key\ TS Signature �Iau Date a l3 L
Ravisim date 202017