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HomeMy WebLinkAbout924 SHIRE CT - APPLICATIONS - 8/24/2012Planning, Development & Transportation City of 281 N. College Ave PA. Box 580 Fort Collins Fort Collins, CO 80524 /,"7 Phone 970416-2740 Fax 224-6134 OVER -THE -COULTER 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) O Gas Lighter 0 Gas Log 0 Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Hoofing Sewer Line O Photo -voltaic O Veritilation p Naler Heater O Water Line 0 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. 7� Application # 6ICx_u Date O `C (a c(AD for olYrce use only Job Site Address (rennired) Value of Construction (labor, materials, profit) _ 9 a . s hi r i✓ S3(991.00 Property Owner Name Address city/state Zlo Phone w0 rrtvt SH2r(Aan 5_24 Sir 61G1. EC Go Applicant Name Address City/State Zip Phone �St��; r� hri 1� Ions 04V L44 F4, 6,LAL � ra 90 )l )-4Q-.4 .4R4i Contractor+ Address city/State Zip Phone '/ iQlin,n �v.rv�t+r. Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 0 Here Report Sales tax number is regvired by all cw kactom Are you paying with your trust account? )K Yes ci No Is this a residential or ommercial project? Z'Residential CI Commercial If residential, is it: Single Family Detached D Condo/townhome (single family attached) Cl Duplex Multifamily (apartment) ❑ Garage If commercial, Is it: O Bank ❑ Bar ❑ church © Hotel/Motel (O Medical office • 0 Office ❑ Retail 0 Restaurant ❑ Other (ex I) Is this building So years of age or more? O Yes No !f yes, you may need to contact HIstoric Preservaaon If this is for a demolition permit, what year was the ilding constructed? If prior to 1975, you will need an asbestos assessment to submit with this application. :ion, of work _._)ecA\)a_4ioyi at re —pail 0� 2� I C-EIYiC+ �S e.W Cr UKe• t-UN - air "if lawn sprinkler/backnow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician. Subcontractors: trsfthe tompanynameorRYofRCnliinslicense 0 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 ail 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: hQrrl Print Name: 6riA� Signatur Date T/T:a6ed t7LT9t7226:01 9"b b8t7 oL6 ao?naaS uaiiu:woJd 6£:aT 2Tw-t72-9nu