HomeMy WebLinkAbout4342 SHADOWBROOKE CT - APPLICATIONS - 4/22/201304/22/2013 09:00 FAX 970 686 6087 AMERICAN AIR DATING INC 4 CITY OF FT COLI.N fz].1001/001
/ Planning, Development & Transportation
F®Cit�+y}Collinsf kj' f L 281 N. College Ave P.O. Box 580
i ` � 7 . Fort Collins, CO 90524
rr ( 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). I'1'Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
lirHeat rig Unit ❑ Lawn Sprinkler ❑ 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 applif�ble information on the application. Incomplete applications will not be accepted.
Application # IJ I Sol 6929 Date hl --2-2
For office use only
job Site Address (required) Value of Construction (labor, materials, profit)
35�A S,SA,)aW brZ)4& C�. $ 3 `l7 5 r
Property Owner Name Address
City/state ,
Zip
Phone
3e ✓e 4 M k r ; e JVAA
owbd'Qake. U, F'C •
`9D5rt
A" - 972 3
Applicant Name Address
City/State
Zip
Phone
Contractor Lie #' Address
City/State
Zip
Phone
/ 4
HeriP4"1�tPA� 39.35// 5-b(/7 e.ari%hUr.#F WrndsSpr C
a0• 60 0
970(o�(o�(��(P
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
mere ❑ Report
salesMn Mber&reyuirE,dbyallcm actors
Are you paying with your trust account? 421"�es ❑ No
Is this a residential or commercial project? lfflResidentlai ❑ Commercial
If residential, is it: I rSingle Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
❑ Multlfamlly (apartment) ❑ Garage
if commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
E] Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes 13 No If yes, you may need to contactHislnric Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to i975, you will need an asbestos assessment to submit with this application.
Description of work i?e Ficrna� �i fHIG
*If lawn sprinlder/backfiow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
5ubwrrtractorse U& Me company name orOty of Ft Collins license #
Eketoidan n # leZ `e e, 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 unbi it has been paid and issued.
n /'
Perin Name: �'k✓"r I�G�u� `� giynature �n �SLI/ pate 7` A2 -13