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HomeMy WebLinkAbout645 STONEHAM CT - APPLICATIONS - 9/14/2011-SmccAr aj l . C., tion CollinsqbF8r1tClins,ODAe52PO.Box SSQ V � r Phone 970-416-2740 Fax 224-6134 OVER- E PERMITS L This application. Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning 17 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler Q Mobile Home replacement ©Roofing ❑Sewer Line ❑ Photo-vokaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑. Wood/Pellet Stove (must be EPA certified, provide make, model and manurer). Compiete all applicable information o the application. Incomplete applications will not be accepted. Application # Date For ofteamonly F I . Job S fte Adftm (squire) Value of Construction (tabor', materials, Profit) 6 y 5 Stogy � � R 69145 %25 $ t �400, 00 Property Owner Flame Address City/stage Zip Phone (506 o v 09 S r*e l ink Cf 01 i,ns CO $05zS a -- a Applicant Flame = Address city/State Zap Phone Te s . Zd . L00e Qvi 4 Co 9053 66 7-/ ZC Contractor UC # Address City/state Tap Phone Ten-S bgfiLq 9-19-73.54ME Contractor City of FL Collins Sales Tax # Are you paying taxes here or by mart? tS Here Report Sys tar nwwber a rsprdied By aff clad= Are you paying with your trust amount? ❑ Yes No Is this a residential or commercial project? ® Residential ❑ Commercial If residential, Is it: 0 Single Family Detached ❑ Condo/townhome (single family ate) 13 Ouplex Multifamily (apartment) ❑ Garage N commercial, is it: ❑ Hank C] Bar ❑ Church ❑ Hobe!/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other ( lain) Is this building so years of age or more? O Yes No If ye4 you nw need to ao Nls�rnc Pl esenrat�on If this is fbr a demolition permit, what year was the building constructed? Ifpnior tb t975, ytw will need an ash agent to submit wltti do aAak3bft of work *if sawn sprinider/6edkliow .preventer, must list. licensed plumber. If first-time A/C, must list licensed electrician. • Lut fe con?p W name or Qy of Ft C,al/ins license # aedrtdW Plumber Me&,V w Roofer Other - I hereby acid that I have read this appikation and stale that the above information is complete and Correct I agree to comply with all requirements contained herein and city ordinances and state taws regulating building won. I know that e permit Its not valid untU it has been paid and €slued. AppftMvb Print Hanve:�eCII/ . dlt. —SlOmsitu