HomeMy WebLinkAbout643 PARLIAMENT CT - APPLICATIONS - 8/30/201108/30/2011 13:07 3032923387 PREMIER PAGE 03/06
city of
Fort Collins
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). G Air Conditioning
0 bemolition (interior non-structural) O Electrical Alteration (not service change = Gas Lighter ❑ Gas Log
L3 Heating Unit Lawn Sprinkler :) Mobile Home replacement iXlRclofng E Sewer Line Photovoltaic
O ventilation C Water Heater C Water Line n Wood/Pellet Stove (must be EPA certified, provide make. mooel and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application = W 2-v Date 8 3� 11
,c f OFIce use on"y —
Value of Construction ;labor, rneterials. profit',
lob Site Address ;'required]
LP43 F oYt i alXY1A �r I DO . �u
Property Owner Name
Address City/State Zip Phore
1� 3 l i O�rYIR i► i Fat tLl i nt �525 Q 70.7-�q 571)
Applicant Name
Address City; State Zip Phone
CAs Calvin 2gr1D W.13*PDX DWYU tD 802D9 3o3.gg9.3gD2_
Contractor
Address City/State Zip Phone
PrtmI;w �oo�+' CD, 25'7Dw•8 AL>t [) VP� CD So2o�F 3D� a33.�lPlo3
Contractor City of F[. Collins Sales Tax Y Are you paying taxes here or by report? IC Here C]Report
re Ayou paying with our trust account? _ Yes No
Sale fax number 4 �eoui.�Cc by' ar. ont -rcrs. p g y ,
50r140 —
Is this a residential or commercial project? Jg Residential ❑ COmmerUa
If residential, is it' Single Fa^vly Detached Q Cordortownhpme (s,ngie family attaCned; i=: Duolea
O Mult`amily (aoartment) ❑ Garage
if commercial, is It: ElBank ❑ Bar ❑ Church ElHotel:MOtel ❑Medico! office- C Office Cl Retail
Cl Restaurant ❑ other (explain; —._.. .._
Is this building 50 years of age or -ore' ❑ Yes JKNO ,r`yes. YOU ^7Z/,7deC tC C017tact HiSCoric PreS6, aticr,
If this is for a demolition permit, what year was the building constructed?
1f prior to 1975. you will neee an aSoes`rs assessment tc submr vrirb cars applicec/cn.
Description of work Teal' o•F e.)Cls'Fi��X �- YQ P1aCC w/ DInLQY1�
'If lawn sprinkleribackfiov oreventer, must list licensed piumoer. If first-time AX, must list licensed electrivan.
Subcontractors: eist toe company name pr city of Ff Collins bcense =
electrician ?!•�nbCr-- f!ec .arza�_ n00:.. _.. __ —
i erebY acknowledge that 1 have reap this application ano state that the above informa:jon is c0moiete and correct- : agree to
comply with all requirements cdn;aineo herein and city oro mances and stale laws, eg�lapnc ` iIC..^5 cor scr orlon. I know that a
permit is not valid until it has been paid and issued.
Applicant: Casn lit
print Name: ey'. lln
.
Signature
gt 3a I i
Date __.... _ _