HomeMy WebLinkAbout4721 DUSTY SAGE DR - APPLICATIONS - 10/6/2011Qot 06 201.1 6:50AM HP LASERJET FAX
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Planning,
281 N. College A�t& n
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Fort Collins, CO BOS24
Phone 970-416-2740 F:av 224-6134
OVER-THE.,CpUNTER PERMITS G�l-7 r
This aPpliioaatlon is to be uMd to apply for following OjgLy
CO DemoNgon (interior non-stnrotura 9 Pwmih only ((ohkk all the a
Heo g Unit q lawn 8 rinkfor Q ElecMOW Alteretfon (not as PPW. Q Air Cordhioning
D Vsritl P Q MobNe Home replacement change) O Gas �tst 0 Gas Log
bttlw► O Water Heater 0 Water line ❑ Woodlpellet Stove rn�ng 0 Sewer Una Q Photo-voltak
mariufacptreo• (uat be EPA cer'tlfied, provide make, model and
Cofnpista ail WOOING Inforlmation on the appllcatlo I
Application #
rwal%V c. Qh'
Job SPoa Addt>tla� pe%*W)
Appifcam Name
Can"ClOr lit # l2 2t (
Conte �y of R, Collins Sam #T
n. nopmpmm applhmd*ns will not be aaoepted.
----�-
Date
Was of Conatructlab (labor, materials, profit)
Address City/�t� ZIP Phone
Address City/State ZIP Phone
Address City/StAbe Zip Phone
Are you paying farces mere or by nepom M Here C1 Report
Are You Paying with your trust account? t8"Te $ *No
Is this a re"rtlal or Proms Residential O Commercial
If ►esldentlal, is it13 SUgfe Farnliy Detached ❑ CDn*VtDwnhome (single family attached) ❑ Duplex
If corrmwdel, Is It: ❑flank i7 garChurch O Garage
Motel O Medical office O Office O Retail
�Stdwant El Other (explajn)
Is this building 50 yeaitt of tge or more? O Yes Ix No 17y� yvu /My 1wed to �axt qwy��
If this la for a demolition what year was the building constructed?
n'Afft m 197$ J /'XW an aster Jtto SubmVr wlf/r ft& fir,
P►evanber, must fist Iloensed plumber, If filet -time A/C, must list Iloensad eledrklan.
5VUWn rsr�Durer W"cbmp�grry4671C orOty Of Ft [ Wit AkWW s*
Plumber Necltania�� Roofer
Other
I hereby adarowladga that I have read this appbcatton and stele that the above information is complete and c offect I agree to
aun* wfth all M*kwnw= contained herein and dty 04renCes and state laws regulating building consbuctlon. I know that a
pennit Is not wild until It has bean Paid and Issued,
Appllcanlr
Print: Nsmar Slgnwtun
Date -Z �.L