HomeMy WebLinkAbout425 ALPERT AVE - APPLICATIONS - 12/8/2011���
g. th sun* & Trarortedon
281 N. College Ave P.
FortCityCollins Fort Ccd nsCO 80524 O. Box 580
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following pa ii ft only (,heck all that . D Air C:ondWw ft
❑ Demolition (inbew non-structural) turai) 0 Electrical Afteration (not service change) 0 Gas Lighter O Gas Log
O Heaft Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 01 Rooliing 0 Sewer Line ❑ Photo -Voltaic
0 Ventilation ❑ Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complefo all fi' on the application5. h to applications will be accepted.
#71 V Date 2'' _ A App
f � O Adlafs (,�,� Vwue of n , (later, c)
jy s P.�nror C, QA { j S $ j 400.
Property Owner. Name Address
ClLy/State
Zip
Phone
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Applicant Name Address
City/State
ZIP
Phone
7Z 9
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Co j 4C6 - -:) .3
Contracbor ' Uc * Address
City/State
ZIp
Phone
R-!.173
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Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? -
® Here ID Report
aW A?xnwnder& bya#
Are you paying with
your bug account?
® Yes > No
Is this a residential or commercial project? 17 Resideritiai 0 Commerdal
If residential, is u-- 0 ale Family Detxjied 0 Condo/wwnhome (single family aftacheM 0 Duplex
O Multifamily (apartment) 0 Garage
V commercial, is it 0 Bank ❑ Bar 0 Church 0, HWJ/Mot el 0 Medical office 0 Office ❑ Retail
0 Restaurant 13 Crites (explain)
is this building 50 years of age or more? 0 Yes ® No . ff yM ynu may nerd to cwArct hFsft c
If this is for a demolition permit, what year was the building constructed?.
Ifpr1hr to 1975, you wit/ need an a 0gfts amemment to =Omit m1h M& appffcaffm
Description Of work 1 ZA a czFF a C-&i`j z u s /ax,.CF — l RC'2 "az
3o YeAR
*If laver preventer, must list Goosed plumber. if first-time Air, must fist licensed electrician.
Subeontr--11 s: List the campmy name or Qiy off` Co01as hbwm #
Bedridan Munbw Rooter 6 ,4sf9J_- otiter
I hereby adGxNvWge that I have read ties appkEd on and stabe that tine above kdbm lWn is oompleft arW correct I agree t>D
comply with all requiremerft contained hen and clty,ordnarmxs and st 3t a lams regulating balding consiructim I know that a
permit is not valid until it has been paid and limed.
Applicaft
Print Name: