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HomeMy WebLinkAbout328 W MOUNTAIN AVE - APPLICATIONS - 6/14/201306/07/2013 08:06 9704844373 BALANCE POINT PAGE 01 City of , F6rt Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER -TIDE -COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). kir Conditioning ❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log 14 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic 0 Ventilation ❑ Water Heater EI 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 •# f3i 00 aq 11co For office use only � S0 -IS Date ((1611,3 to-iy-13 Job Site Address (required) Value of Construction (labor, materials, profit) 3a8 W, /44ou afro Aye-0 117, ?604a 0 Property Owner. Name Address City/State Zip Phone Clay o-F F4, C011:as R'0,Box 690 R Caflfu►F,Co. Sol.? Applicant Name Address City/State Zip hon 46 P341-ome (� Contractor Address uy/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here fiKkeport Sales tax number is- required byaiimntractom. Are you paying with your trust account?1DYes ❑ No _ 7,4, IS LhiS a resldentlal or commercial project? E f Resldentlal ® Commercial If residential, is It:. U Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex © Multifamily (apartment) ❑ Garage If commercial, is It; ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant Other (explain)tku_vrG eser 4q-_is iuue%d) Is this building 50years of age or more? g Yes ❑ No Ifyes, you may need In contact Historic Presel'vat/on If this is for a demolition permit, what year was the building constructed? if prior to 1975, you will need an asbestos assessment to submit with thls application. Description of work Ke��: —��A ou r( Khbt *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 0 Electrician__ PIUmber_ 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. Appdcaht: Print Name:._..GSignature Date (OW/3