HomeMy WebLinkAbout449 DENNISON AVE - APPLICATIONS - 9/22/201109/22/2011 15:36 3032923387 PREMIER PAGE 02/06
City of
Font Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 00.416-2-740 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). 0 Air Conditioning
O Demolition (interior non-structural) 0 Electrical Alteration (not ice change) p Gas Lighter - p Gas Log
0 Heating Unit 0 Lawn Sprinkler ❑Mobile Flome replacement Roofing 0 Sewer Line 0 Photo -voltaic
0 Ventilation 0 Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, (node( and
manufacturer)..
Complete all applicable information on the apolication. Incomplete -applications will not be accepted.
Application # Da
for oflrce only � �.��
Job Site Address (requied)
Value of Construction (labor; materials, profit)
44 _ DAAYVW_
&_uCAALq q o0
Property Owner Name
tolfwan__pb `d
Address City/State zip
44q a Ft.�►l�ns g0525
Phone q70•
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Applicant Name
Address city/Stage zip
Phone 303.
I� GDt1.t,Y1
- a5'1Q8-4- a2,n.Ler CD
4 C)4q . 310
CA
ntractvr
Address City/State Zip
Phone 308
ntractor Cityof FL Collins Sal
Tax # Are y report. �CNere 0 Report
you paying taxes here orb ?
,7 or rrauo�x
Are you paying with your trust account? 0
Yes ')-(No
4 ois a residential or commercial project? XReOdential O Commercial
1If residential, is it D Single Family Detached (3 Condo/townhome (single family attached) O Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank O Bar ❑ Church ❑ Hotel/Motel O Medical office 0 Office O Retail
C7 Restaurant 0 Other (ex lain)
Is this building SO years of age or more? ❑ Yes No t yeS, you may neeO to contact ftfaric Preser wo`on
...
If this is lior a demolition permit, what year was the building constructed?
Ifpnor to 19n you will need an asbestos assessment to submit Na7h this 4q licatr6n.
Of
*If lawn sprinkler/badd�low preventer, must fist licensed plumber. V f1tswtime A/C, must list licensed electridan.
Subcord aetors; ,Gist the cbmparry name or Gly of ft Co//ms /iC>° M +7
Frectr+dan _ _ Plumber Mechanical _ Roofer Other
(.hereby acknowledge that.I have read this apphcapon 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,ond issued.
a,
Applicant:
F nj
iarint Name: W __ l 14' Slsnature_ bate �l •`F� .�