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HomeMy WebLinkAbout924 DEERHURST CIR - APPLICATIONS - 8/13/2013FROM :NCR FAX NO. :9702299983 Aug. 13 2012 03:36PM P2/5 Planning, Development & Transportation City Fy Collins 281 N. College Ave P.O. Box 580 Fvrt �.. 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). kir Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit El Lawn Sprinkler ❑ Mobile Home replacement 13 Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water 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 # "I Fo office Use only Date 2-1 ?_2 2 Job Site Address (required) Value of Construction (labor, materials, profit) IL _....^ Property Owner Name Address oty/State Zip Phone to ( Z Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone �I %Z r'°sAve. _Pi7coNios CO ry 2 �7�0 Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XReport Sales tax number isrequimdbyaamntractors. Are you paying with your trust account? VYes ❑ No �2 k- Is this a residential or commercial project? A Residential ❑ Commercial If residential, is it: kZ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex Multifamily (apartment) ❑ Garage If commercial, is it: © Bank ❑ Bar ❑ Church ❑ Hotel/Motel El Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain Is this building 50 years of age or more? ❑ Yes "o 1f yes, you may need to contact Historic Preservation 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 this application. Description of work *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan. Subcontractors: List the company name or City of Ft Collins license .f Electrician W1 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 until it has been paid and Issued. Applicant: Print Nam Data '7"I