HomeMy WebLinkAbout1225 W Prospect Rd - Applications/Furnace - 09/07/2018Corninun ity Development a Neighborhood Services
1^� 281 Forth Colieae :;venue
or'. colkins. c0 8os24 iviain: 9 0.410.2740 Pax: 910.224.6134
This application is to be used to apply for the following per remits only (check all that apply). it Conditioning
❑ Demolition (interior non-structural) ❑Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Loo
`)"Q Heating Unit ❑ Lawn Sprinkler ❑ -[[Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Healer ❑ Water Line ❑ 1rVood/Pellet Stove (must be EPA ceriried, provide make. model and
manufacturer).
Complete all applicable information on the application. incomplete applications will not be accepted.
Applica Mon 7 I`' \ 190,9 6nz:> Dare _ CI l 1 S
For office use only y 2
j �t ' °ee r' y+.; e55 (reauirecl V@k?e! Or CcRstrVci_son (labor, materials, profit)
N-zn ,14gq °�
I Property 0%,vner fume Address City/State Zip Phone
zzt-
ones-r k r_fMfffiis , 1225 w. PM R8 Vc,5? 62 I
I
Applicant Name Address Cit-y/SLaZE Zip Phone
I yfia�n ?kuQy bsnu_�IlULI �`�. s'�x� ���liy� 80544 418L1
1 Contrttraact}oorr `a Address City/State Zip Phone
' p ¢� S� qqR q
�iriAVI S [�Sj�t '� ksb fi S UjT b 1 V_JL \ � ��p}-b1./�(�
NM S
Contractor City of Ft_ Car ins Sales Tax =� c Are you paying taxes here or by report? ❑ Here ❑ Report
Sales iax numher is required by all conoacrnrs: Are you paying with your trust account? ❑ Yes F—I No
i
I s this a residential or commercial project? sidential 0-Commercial
if residential, is it: Ci 5ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
_ Multifamily (apartment) ❑ Garage
ti commercial, is it: I Bank L Bar ❑ Church ❑ Kotel/Motel ❑ i�iedical office ❑ Office ❑ Retail i
I ❑ Restaurant ❑ Other (Explain)
i Is h0s building 5C years of age or more? ❑ Yes ❑ No Lfyeg youmayn ctHis[oricPreservation
r j
fhis is for a der<oi don ermit, what year was the building consruc . .
Description of work r 1•S �
'_f lawn sprinklerihackla / preventer, must list licensed plumber.C, ,:,U5_ @25_ Bice„sec eyed, icz�•
�cac_ recce: s: %ist the company name or City of Fr Coi/iris license
_Mec—,ndan Plumber McCiBnicaal Roofer Other
hereby acknowiedge'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 sate laws regulating building construction. I know `chat a
ernli't- Is not- valid unLif it !s as been _^paid and issued.
,e: Signature
I �
M
R=_v MdaL2FS01
328