HomeMy WebLinkAbout421 PEYTON DR - APPLICATIONS - 9/30/2011Sep 30 2011 6:25RM HP LASERJET FRX
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City of,
o�uns
Planning, Development tf1 Tnanaportatlon
281 N. College Ave, P,O. Box 590
Fort Collins, CO 80524
Phone 970-416-2740 Pax 224-6134 15ZP
OVER-THE=COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (chock all that a
13 Demolition ( , tsrlor non-structural) O Electrical Alteration (not sore change) 0 Gas Lighter ❑ Gas Log
Cl Air oning
0 Heating Unit E3 Lawn Sprinkler O Mobile Home replacement Fooling 17 Sawer Line 0 Photo-vonalc
❑ Ventilation ❑ Water Heater 13 Water Line 0 Wood/Pe11et Stove (must be EPA certified, provide melee, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applicatlons will not be accepted.
Application # O �72 Date 30
fix o/la<cz use arvy
Job Site Address (rslpairnd) 7Value of Constn ctlon (labor, materials, profit)
Z h :j
Property Owner Name Address City/Stator ZJp�
r .n ..
.... Applicant Name Address City/State
Zip Phone
Contractor Uc M-z Address City/State zip Phone
1 1 - ,
Contractor City of R. Collins Sales Tax # Are You p�n9 taxes hereor by report? M Uere ❑ Report
N W ^&#Ubff— A i L \ �/►bmldws Are you paying with your trust account? NrVes tp No
Is this a residential or copmemial pro)ect7 12"kesldenpal 0 Commercial
If residential, Is It: WSIngle Family Detached ❑ Condo/townhome (single fam0y attached) 0 Duplex
0 Mukftmlly (apartment) 17 Garage
If commercial, Is It: O Bank 0 Bar 0 Church ❑ Hotel/Motel ❑ Medical office O Office 0 Retail
G Restaurant C] Other (explain)
Is this building 50 years of age or more? O Yes O No ffM you may need to Corned y/Wnc pMjVrvabbn
If this Is fore demogtlon permit, what year was the building constructed?
!)'prior to 197S, km "heed an aadestes azemwent to sub"* We di/s app//caebn.
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician,
SubcoMa n rs: List the mmparry name or Gty o/ft Codbls lkLonse a'
i]edridan Plumber Mechanical Roder. Other.
I hereby adv owiedge that I hove reed this appllcatton and state that the above Information Is complete and correct. I agree to
campy with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit Is not valid until ft hall bean paid and lasued.
Applicants
P11nt Noma: 71 �� ✓) signature
Date 01 .-30 " II