HomeMy WebLinkAbout918 RICHMOND DR - APPLICATIONS - 7/19/201306/05/2010 0 2 : 5 9 #0825 P.001 /001
Ci ty0f planning, Elvelopment & Transportation
281 N. College; Ave P.O. Box 580
llins Fort C Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
VER THE -COUNTER PERM,ITS ONLY
This application is to be used to apply for the following permits only (c"k all that apply). Wir Conditioning
09birnoliflon (inter i r non-structural) ElElectrical Alteration (not service change) ❑ Gas Lighter' O Gas Log
Heating Unit Eliemn Sprinkler ❑ Mobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation ter 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 # Date
For �ffiae use only
Job SiteAddress ui'red) Value of Construction (labor, materials, profit)/
CAR
Property Owner Narr
a Address
City/State Zip Phone
Applicant Name
Y p
Address
City[State Zip Phone
rFG ICC -Aoci
Contractor
c # Address
-7
City/State Zip Phone
barne
Contractor city of FL
5
akstaxnmberl]Fro7mzwbyallcon&acmm
Wins Sates Tax #
Are you paying taxes here or by report? ❑ HJpW Report
Are you paying with yolur trust account? es ❑ No
Is this a residential
If residential, is t
If commercial, is it;
Is this building 50 yi
If this Is for a demo
Ifprior to 1975, you
Description of
*If lawn sprinkler/back
Subcontractors: List
I hereby acknowledge
comply with all require
permit is not valid t
tmmerciai project? residential ❑ Commercial
Single Family Detaiched I jAondo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
Bank Q Bar ❑ church ❑ Hotei/Mots1 ❑ Medical office ❑ Office ❑ Retail
Restaurant ❑ other (explain)
s of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
in pelnnit, what year was the building constructed?
(need an asbestos azesmwnt to submit with this application
must list licensed piumtler. If first-time A/c, must; list iicense� electrician,
company name or Gty of Ft Collins lice
Plumber M P33 L Mechanical Roofer other
I have read ttns application and state that the above information is complete and correct. I agree to
is contained herein and city ordinances and state laws regulating building construction. I know that a
it has been paid and issued.
Applicant- rint Name: Signature i1� Date 9
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