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HomeMy WebLinkAbout4454 VISTA DR - APPLICATIONS - 8/13/2012RUG-13-2012 13:01 From:Allen Service 970 484 4448 To:92246134 Pa9e:6�8 City of Fort Cottins Planning, Development &Transportation 281 N. College Ave P.O. Box 580 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 AtE)emolilion (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter/ ❑ Gas Log eating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line.. ❑ Photo -voltaic entilation p Nater Heater ❑ Water Line © Wood/Peilet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application- Incomplete applications will not be accepted. Application # 01 On L4 9 2' For office use only Date LzLa 50' ©� Job Site Address Irecuire!tl DR- Value of Construction (labor, materials, profit) .6 7Yro0 Fee I� property Owner Name Addre$S n NA/Yje a ,��1 City/State Zio Phone �Q $�►�� Applicant Name Address Sh6Y1f k �(At City/State Zip P,G�(Uhs��G Phone Contractors Addrels+s���f� C1ty/State Zip Phone '7g�- Q I I l�T�r F44L�41aLv' �O�J� n.n .JO.r• �� Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Are you paying with your trust account? ❑ Here Report Yes ❑ No Saks tax number is 41e00ir01 by anCmt1-actors Is this a residential wolomiultlramily mercial project? JUesidential ❑ commercial Ir residential, is it:ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex (apartment) ❑ Garage ' If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (ex f lain) Is this building So years of age or more? Q Yes Zito if yes, you may need to contact Hlsroric Preservation If this is for a demolition permit, what year was the Ilding constructed? fl prior to 1975, you will reed an asbestos assessment to submit with this application. Description of work • If lawn sprinklertbackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: U3t W COMPOny name orQY 0fRC011ins /icerIse � 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. �y Applicant: �Qtril 66 Print Name: Signatur Oake .