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HomeMy WebLinkAbout4436 HOLLYHOCK ST - APPLICATIONS - 10/23/2012FROM :NCR FAX NO. :9702299983 Oct. 24 2011 02:50PM P5/6 Fort Collins Planning, Development &. Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-476-2740 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 Q Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 13 Gas Log 4eating Unit ❑ Lawn Sprinkler F1 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ 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 # _ ' �s f Date /0 •Z?;;,'"l 2 a for office use only Job Site Address (required) Value of Construction (labor, materials, profit) y_' cl . - P pnarty Owner Name Address City/Statue � zip Phone CLK.WawP_bV, CO Applicant a Address r City/state Zip Phone Contractor Address City/State zip Phone cl_tz) Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here [`Report sales tax nur ober is required by all wnmietors Are you paying with your trust account? Yes ❑ No Is this a residential or commercial project? Pf Residential ❑ Commercial If residential, Is It: Single Family Detached ❑ Condo/townhome (single family attached) © Duplex 11 Multifamily (apartment) ❑ Garage If commercial, Is it: ❑ Bank ❑ Bar ❑ aurch ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? M Yes f No If yes, you may need to contact Historic Preservation If this Is for a demolition permit, what year was tf building constructed? if prior to 1975, you will need an asbestos assessment to submit with this application. Description of work *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license # 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. Applicant: Print Nam Date —1Q _1.3 { L