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HomeMy WebLinkAbout668 JUSTICE DR - APPLICATIONS - 1/20/2014From (303) 583-8348 Mon Jan 20 16:15:52 2014 MST Page 1 of 1 City of Planning, Development & T'ransportation . 281 N. College Ave P.O. Box 580 r t Fort Collins, CO 80524 Phone 970-410-2740 Fax 2.24-6134 OVER-THE-COUNTER PERMITS L ' This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning Demolition (interior non-structural} ❑ Electrical Alteration (rot service change) Q Gas Lighter ❑ Gas Log ❑ heating Unit ❑ Lawn Sprinkler CI Mobile Home replacement €7 Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation p 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 # lC/4O�j�C� L_ -- Date ror office use only — ---- --- TJob Site Address ,'required) — Value of Construction (labor, materials, preit) { jt` � � i. p `{5\}j+f� Property Owi;er Name i ,.c;dress r City/ State p---hore :;'r Zip o Applicant Name r 4 - l '- - -- tj 'i Address City/State Zip Phone / Address City/state. Zip Phone C��// �//'U-4 'I ijc-j Contractor City of Ft, Col€ins*Sales Tax Are you paying taxes here or by report?.-lfHere 0 Report rnumberis.�quredgyatfcont,ictors Areyou paying with your trust account? ❑ Yes aKo Is this a tesidential or commercial project? !2rResidendai ❑ Comr•,.ercial If residential, is it: Q-6ingle Family Detached 0 Condo/townhome (single family attached) ❑ Drr.Dlex 6 Multifarrily (apartment) ❑ Garage If commercial, is it: © Hank ❑ Bar © Church ❑ F;otei/Motel CJ Medical office ❑ Office El Retail 0 P.estaurant E7 Other (explain) Is this building 50 years of age or more? ❑ Yes #r No .fyes, you nkzyneed to cortactHistoric Pnpsarcation If this is for a demolition permit, what year was the building constructed? I`piior to. 7.975,, yotr wi//need an ashestas assessment to sutirnit with, this applies tan. -- 17P.SCiIptIOR O1' YJOrIC !�(•-Y:�<�,`''''_fZ.. `') �^> C ��ir ;t_�i._� r ..,,fit,_>{�2:�.� E�:�` _— ------- *If loam sprinkler/backfioty preventer, must list licensP.ri pkim ter. :f first-time A/C, roust list licensed electrician. Subcontractors: List the company name or City ofrt CelUns 1.%tense g Number� '"`i `� h:ect nical — Roder--- 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 ocontained herein and city ordinances and state !a,vs regulating building construction. I know that a Permit is not valid until it has been paid and issued. Applicant: Print Name:_ . ... l � SinaZ? Date