HomeMy WebLinkAbout430 BUTCH CASSIDY DR - APPLICATIONS - 10/28/2011Cltyof
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'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 thatapply). ❑ Air Conditioning
CI Demolition (interior non-structurai)� 0 Electrical Alteration (not service,change) ❑ Gas Lighter ❑ Gas Log
11Heating,Unit 0 Lawn Sprinkler q!Mobile Home replacement 12 Roofing ,1 Sewer Line 11, Photo -voltaic
Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified,, provide make, model and
manufacturer).
Complete all applicable InfURIWI�7D_
orrmatiionon,the application. Incomplete applicatl ns will not be accepted.
Application # � to
Porolii'ce use -only
Sob Site Address regglred)
Value of Construction (labor, .materl Is, refit)
I Property Owner Name
Addres
Q /State ZIP Phone
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Applicant Name
Address
City/State ZIP Phone
Gontractor
Address
City/State Zip Phone.
Air Comfort, Inc 150 Rome Court
Fort Collins,, CO 80524. 970-490-1458
Contractor City of'Ft. Collins Sales Tax #
Are you paying taxes here,or by report? L Here ❑ Report
Sales texnrmberIsrequIred,byaumntractom
Are -you paying with your trust account? M Yes ❑,No
31791
Is this a residential or commerclal project? P'Residendal ❑ Commercial
If residential, Is it: ❑�gle Family Detached. ❑ Condo/townhome (single family attached) ❑ Duplex
®'Multifamily (apartment) ❑ Garage'
If'commercial, is it: ❑'Bank '❑ Bar ❑-Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑;Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age,or more? ❑ Yes. ❑ No 1fym yov ngyneed to contact NlstodcPrnseivation
If this is for a demolition permit, what yearwas the building constructed?
f prior to 19yS, yoo hill need an asbestos assessment to stibmit with this a pl/cetlon•
Description of work
fja
*If lawn sprinkler/backflow preventer; must list, licensed plumber. If first-time NC, must listiiieensed electrician.
Subcontractors: Ust Oe canpany name or aty of Ft Cblllns /tense
Becbidan Plumber Mechanical 141321 Roofer Other.
I hereby acknowledge that I have read this•applicadon andfstate that the above information is complete andicorrect. I agree to
comply with all requirements.contained°hereinand city ordinances and state laws regulating building construction. I know,thata
,permit is -not valid until It;hasibeenpaidand Issued.
Applicant: /;
Print Name( I K nSignature„ Date D �r
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