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HomeMy WebLinkAbout6020 HUNTINGTON HILLS DR - APPLICATIONS - 12/19/2012FROM :NCA FAX NO. :9702299983 Dec. 19 2011 01:13PM P5/11 Flirt Collins Planning, Development 8r 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 ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line 13 Photo -voltaic 4 Ventilation T Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable informati/onI on the application. Incomplete applications will not be accepted. Application # ' ? 1) 0014 Date Forofl5ce use only Job Site Address (required) Value Of Construction (labor, materials, profit) �� ��V --J 1(5�7— _..... __ _ Prope Owner Name Address City/State Zip Phone Applicant Name I Address City/State Zip Phone Contractor Address City/State Zip one qt YD col.so L ..� 3') Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XReport Sales tax number rsrequiredbyallcontractors. Are you paying with your trust account? I<Yes ❑ No — oI ip8'La Z Is this a residential or commercial project? RfResidential ❑ Commercial If residential, is it: ingle Family Detached ❑ Condo/townhome (single family attached) 0 Duplex 'l] Multifamilyly (apartment) ❑ Garage If commercial, is it: ❑ Bank Cl Bar ❑ Church ❑ Hotel/Motel ❑ Medical office © Office ❑ Retail ❑ Restaurant ❑ other (explain) Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Histaric Presetvation If this is for a demolition permit, what year was the building constructed? Ifprior to 1975, you will need an asbestos assessment to submit with this application. Description of work . ��{PO�- LA-7 *If lawn sprinkler/backfbw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Ust the company name or City of Ft CoNlns //tense # Sectrlclan 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 12 ( - 'I L __