HomeMy WebLinkAbout927 WESTFIELD CT - PERMITS - 9/16/2021:I ':
City of
ktColli~
Community Development & Neighborhood Services[
281 N. College Ave Fort Collins, CO 805?~.·, i: , , i :
970.221 .6760 970.224.6134-tal i 11:
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Building Permit#: B2107451 i I
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iii kddress: 3927 WESTFIELD CT
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Issued Full: 091 1 s,2021 · I
Permit Type: Residential Gas Lo~!
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Job I aluation: $6,000.00 Cate gory: Residential
Owner: BROLYER JUSTINE REVOCABLE Phone: 970-988-1591
TRUST
3927 WESTFIELD CT
Zoning: Front Setback:
Minor Amend#
Zon ing District
Legal: Subdiv is ion/PUD:
Rea r Setback ____ Right Setback:
Plat Fi le #: ____ ZBA Case#:
LMN -LOW DENSITY MIXED-USE NEIGHBOR HO OD DISTR ICT
Fi ling #: __ _
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Left Setback
Lot#: _19__ Block#: _1 ___ ,;;
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Code: Res sq ft Com sq ft :
0cc Group
In d sq ft Basement sq ft: , i1' :l ------1,1 ':
# of Stories· Const Type
Stock plan op ti ons: , 1 . Fire Sprklr Stock p lan #:
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c~1iractor: WESTERN FIREPLACE SUPPL y · ! I 1408 RIVERSIDE AVE
f i I FORT COLLINS, CO 80524
License#: FP-1815 Supervisor Cert#: 3366-FP
Phone: 970-498-9679
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Subcontractor( s): License Number:
Work Description : Rep lace gas fireplace. Hooking up to existing gas line.
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SCHEDULE INSPECTIONS: **via Text Message: 888-406-6394
Online Portal: fcgov .com/CitizenAccess
Possible Inspections Required: 406 204
TOTAL FEES PAID AS OF 9/16/2021 : 204.50
***Fee Detail Displayed on Next Page
**By Phone: 970-221-6769
As a condition for the issuance of a permit, I hereby declare that I am the owner or own er's agent. authorized to perform the proposed work on the
property described here in. I agree to comply with all the requirements contained herein, and City ordinances. and State laws associated w ith such
work I understand that such permit m ay be revoked in t he event that issuance was based on inco rrect information This permit shall become null and
void if the work authorized by such permit is not commenced. suspended, abandoned or not inspected within 180 days from tt1e date of such permit
Carbon Monoxide Alarm required within 15 feet of each bedroom entrance.
Signature: Print Name: -----------------------Date: --------Form Revised July 2021
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i: Fort Collins ~!!!!::ii------~--
Site Address: 3927 WESTFIELD CT
.Job Val uation: $6,000.00 Category: Residential
Transactions:
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Community Development & Neighborhood Service~ I
281 N. College Ave Fort Collins, CO 80522
970.221 .6760 970.224 .6134 -fax
Building Permit#:
Issued Full:
82107451 .
09/16/2021
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Permit Type: Residential Gas Lo~,
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Method Ref Number
C~ep it Card 3030
Date Paid
09/16/2021
Amou nt Paid
$204.50
Comments I
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:rft' Paid to Date: ~$2~0~4~.5~0'-----
Description
City Sales/Use Tax
County Sales/Use Tax
Permit Flat Fee -$65
TOTAL FEES:
Fee Amount
$115.50
$24.00
$65.00
$204.50
Amount Paid Date Paid
$115.50 09/16/2021
$24.00 09/16/202 1
$65.00 09/16/2021
$204.50
TOTAL BALANCE DUE AS OF 9/16/2021 :
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$ : '
Amount Due
$0.00
$0.00
$0.00
$0.00
$0 .00
Fee amounts are valid for date of this document only. Fees subject to change without notice.
Form Revised J uly 2021
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Cityof
ktColli~
Community Development and Neighborhood Services
281 N College buildi ngservices@fcgov.com
Fort Collins, CO 80524 970-416-2740
GAS/WOOD BURNING APPLIANCES
PERMIT APPLICATION
Application# B'J/6 745]
Date Recei ved Of , I ft • 1., (
ALL information is REQUIRED. Incomplete applications will not be accepted.
Job Site Address
Address ) i ).,-? V 6b 7 f f, · ~ / d Cf_ City/State/Zip -~-=---<>--~_Z.._~----
Phone Number _o/_J_v-_-_C/_/6_/p~--/~J_-~9_/ __
City/State/Zip 'p'"'" J 1.. l,
Property Owner Information
Name ✓ // 7 f .'n +: /f/7 r, · / I} r ~7 tr°
Address fr9 k 2 VP jr f,·e Id cf:
~ingle Family Detached O Townhome (attached) Q Duplex 0 Apartment/Condo Q Garage/Other
Q COMMERCIAL 0 Bank O Bar O Church O Hotel/Motel O Medical Office O Office ORetail 0 Restaurant
Value of Work
Labor and Materials$ -~"--C_C<:J-__________ _
Scope of Work
r -
! 0 Wood/Pellet stove (required to be EPA approved) Model Name ________________ _
Manufacturer ________________ _
~ Gas Fireplace Length of extensions of gas line (if necessary) ________________ _
Please list plumber if not completing
0 Fire Pit
Additional Information
(if applicable)
Contractor •
Name If r 'f. j q "7 !l-e W\ ~ J-e I , ·'-'1 .,J
Address / 1, J&>-' (..,,., ·ve 0, 0, V ~ tr
Phone Number {q Cf/ -fl? Cf er f:
ti// 11-R'l//i!r'"'
vv-e ~J-e,-n t · -, e. /.?/ t/1 t-e-
city1s1ate1zip _~_t?~5~_7--_5" __ _
Email e Cfvl @.. n ~ Ce, vr,-~ .~ 7 c,n . c.e,;..h--.
License Number __________ Certificate Number _____________________ _
Subcontractor License (if applicable) _______ _ Subcontractor Name (if applicabl e) ___________ _
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.
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I Print Name
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