HomeMy WebLinkAbout3200 Moore Ln - Applications/Other - 12/18/201412/16/2014 11:38AM FAX 9703527088 ACLEANSWEEP
IM0001 /0001
City of Planning, Development & Transportation
281 N. College Ave P,O. Box 580
Flirt Collins Fort Collins, CO 80524
' Phone 970-416-2740 Fax 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
C3 Ventilation 13 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 # e)ILi) 0259 a;;1- Date la'��`
For ofte use only
Job Site Address Oequirert) Value of Construction (labor, materials, profit)
Property Owner Name Address
oil Kin 32m .J�wt k oun -
Applicant Name A Address
Contractor Address
CMG
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contracwM
City/State Zip Phone
T� NVI&S to ate- 2z3� a
City/State zip Phone
L-6 (�` -P.p, oK a l a yec �g U3
City/State Zip Phone
qua • 334-Rj3(,o '
Are you paying taxes here or by report? 'Here ❑ Report
Are you paying with your trust account? ❑ Yes jxVo
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: ❑ Single Family Detached 11 Condo/townhome (single family attached), C3 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ ear ❑ 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 pteservatlon
If this Is for a demolition permit, what year was the building constructed?
Irpr/or to 1975 you wii/ need an asbestos assessment to submit with this appl/cation.
of work
I/
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or city of Ft G011ins 110?nse 0
dectriclan_. _ 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: IV �a51'a
Print Name;w� 4Q
Signature _ Date—