HomeMy WebLinkAbout612 SYDNEY DR - APPLICATIONS - 9/14/2011City
Flirt CcAhns
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning
G Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler J Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line Q '+Nood./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 #Y2 NOk ' � �paate'01 /ILt�l
For o/irae use only 1-1 " /t
Job Site Address (rrgt#mc0
Value of Construction (labor, materials, profit)
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Property Owner Name
Address City/State Zip
Phone
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F-i L t t IM 00 205215 MD) 29 7-
Applicant Name
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_,Address city/State Zip
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Phone
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contractor Peak -b ''eb�k
Address G /st to Zip
155 .3eCn e).1 t7 ttc+a,7
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Phone
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Contractor City of Ft Ilia Sales Tax # Are you paying taxes here or by report?
VHere ❑ Report
54ias rexruw,'>E<,-g Zi-ad mm�rrectors
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Are you paying with your trust account?
Yes to No
Is this a residential or commercial pmject? ❑ Residential ❑ Commercial
If residential, is it: 1A Single Famlly Detached b tondo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ ear 0 Church ❑ Hotel/Motel 17 Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is tics building SO years of age or more? ❑ Yes Ida No lfyas, you may need to contact Historic Pre5erladon
If this is for a demolition permit, whatyear was the building constructed?
tfprior to 1975, you w;11 need an asbestos ams wment to submit with this app#Won.
I
Description of work Lo o. DL rG fi c hZ uY
?f lawn sprinlder/bacKow preventer, must list licensed plumber. Y first-time A/C, must fist licensed electrician.
Subcontractors: Gist the company name or City offs Collins hcwme rk
Electrician Plumber Mechanical Roofer'-2 Other
i
I hereby acknowledge tkiat I have read this application and state that the above information is complete and correct. ; agree to
Comply with ail requirements contained herein and city ordinances and state laws regulating building constriction. I know that a
permit Is not valid until R has been paid and Issued.
Applicant: j LAP— Signature � Ckx y1 Date "t � t
Print Name: +_add_ (_
MA