HomeMy WebLinkAbout638 KIM DR - APPLICATIONS - 11/7/20112011-11-08 08:45 R-M-R 7205368148 >>
970 224 6134 P 1/1
City,Of Planning, Dwsla
281 N. College Ave
tms Fort calla, co 80!
Phone 970-416.27-
OVER-TINE-COUNTER
This application is to be used to apply for the following permits only (check all 1
0 Demolition (interior non-structuraq 0 Electrical Alteration (not se ce change) 0
0 Healing Unit O Lawn sprinkler 0 Mobile Home replacement Roofing 0 Sev
0 Ventilation 17 Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA 0
manufacturer).
complete all applicable Information on the application. Incomplete applications
APPlication # 6 0 Dane
Forollr am only
rlk Transportation
Box S80
224-6134
NLY
pply). 0 Air Conditioning
.fighter 0 Gas Log
fie 0 Photoaroltalc
I, provide make, model and
trot be accepted. 11 f
Job Site Address (required) Val a of Co
n
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bor,
(la, materials, profit)
Propttity Owner Name Address /State
'i 1ir Eay�ed
P Phone
. � h goy
Q7v�Z/`Y-
Applicant Name Address QN/State
p Phone
DWIVLV TAC-o S I2bs-o w. i5 lI uw;r cg. 0113 A
a oo
Conbadw Address Gty/State
Phone
ADVey wt-rsJ. Co D Iri oaAj6 S
nd -V 4070
Contractor City of Ft. Collins Sales Tax l! Are you paying taxes here or
by
15 Here ❑ Report
6Mestornw►4e+r6-rffgt* dbya#a mmtvs Are you paying with your
account?
0 Yes IILNo
Is this a residential or commercial project? 01 Residential ❑ Commes I
If residential, Is it: a Single Family Detached ❑ Condo/tovmhome (single family a ) ❑ Duplex
10 MultifarNy (apartment) 0 Garage
If commercial, Is it: ❑ Bank O Bar 0 Church ❑ Hotel/Motel 0 Medical office ❑ ❑ Retail
❑ Restaurant ❑ Other (explain) 4
Is this building SO years of age or more? t7 Yes JK No 1f)w yaw may i ed m con Lstnr c Arse w6on
If this is for a demolition permit, what year was the building constructed?
A`Drfar to 1975,•You vdl need an aS&&Mxs asA°.ss:vaent to Mbmlt wadi this app/Aw&n.
Description of work
*11' lawn sprinkk r/baditw pr+eventer, must list licensed plumber. If Orst-Ume A/C, must IM
- I-1n13-I-0 toe LBW dieaunp wnerveorOryoFaCzOw/key0
Plumber. MaMwlml Roarer
I hereby adawmledW that I have read this application and state that the above Information Is
comply with all requlrernents contained heroin and city ordinances and state laws regulating bi
permit Is not vaild until It has been pald and Iwarod.
Applkwit
Print Name: DAN N Y U Ace 23S signature
ete and correct. I agree
construction. I know tl
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