Loading...
HomeMy WebLinkAbout650 BAYBERRY CIR - APPLICATIONS - 4/3/2013APR-03-2013 15:11 From:Rllen Service 970 484 444e To:92246134 Pase:5�14 City of �t 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). © Air Conditioning O Oemolition (interior non-structural} 0 Electrical Alteration (not service change) Gl Gas Lighter 0 Gas Log leating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 0 Hoofing ❑ Sewer Line CI Photo -voltaic ❑ ventilation 0 Nater 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 # 3 13ol STZ For offrce use orrly Job Site Addr ss frearkred) � 6 P 6AV hr9_" f-U ./ , %, _ Owner Namy" Address Date q_ 3-/ 3 Value Of Construction (labor, materials, pr❑Fin City/state Zio Phone yga-as57 A pucant Name Address City/State Zip Phone Contractor Address City/State Zip Phone qvql Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ here Report i Idler tax number is reQwred o� ad cw,rracfors. Are you paying with your trust account? 1 es ❑ No Is this a residential or r mrnercial project, f ��_� ential ❑ Commercial If residential, Is Single Family pe hed ❑ Condo/townhome (single family attached) 13 Dupiex r Multifamily (apartment) ❑ Garage If commercial, is It; ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Q Medical office ❑ Office D Retail ❑ Restaurant CJ Other ( lain) Is this building So years of age or more? ❑ Yes No If yrs, ynu may need [o contact Nfstoric Preservation Ir this is for a demolition permit, what year was the Ilding constructed? 1/prior to 197S, you will nPodan asbestas- assessment to subm/t with thi.F appikah'on. 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. T know that a permit is not valid until it has been paid and issued. Applicant: hVTl 6 r I An i _ Print Name: Signatur Date 41 —