HomeMy WebLinkAbout412 THRASHER ST - APPLICATIONS - 7/17/201207/17/2012 12:19 TEL 9702212533 AIR PRODUCTS 121001
Fart Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
. OVERmTHE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Air Conditioning
molition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line Ci Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appllgqble information on the application. Incomplete applications, will not be accepted.
Application # l a0 q 57� Date Zz % b Z_ 1 �
CAF nA4ro lice nn/v
Job Site Address /redj Value of Construction (labor, materials, profit)
Pr a Owner Name Address
'54;
�-- City/State Zip
Phone
do
Applicant Name Address
City/State Zip
Phone
/o9L W; Z
Contractor Uc # Address
City/State Zip
Phone
141h
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Report
5b/es tar num4er is "ailed by all contractors
Are you paying with your trust account?
es ❑ No
Is this a residential or ercial project? IQ Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) CI Garage
If commercial, is it: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel El Medical office 0 Office ❑ Retail
❑ Restaurant O Other (explair}y
Is this building 50 years of age or more? O Yes WNo If yes, you may need to contact H/don't Preservatlon
If this Is for a demolition permit, what year was the building constructed?
JYprior to 1975, you will need an asbestos assessment to submit wfth b/ is applkadon.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: W b're company name or oty of R Coll/ns ltew se 0
Electriclanfy&jk Plumber Medwnlcal Roofer
.0i0 7
I hereby acknowledge that I have read this application and state that the above Information W 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 /A 6I-4tPI e4SS d
Print Name; _ .Signature
Date G