HomeMy WebLinkAbout6127 TILDEN ST - APPLICATIONS - 4/21/2014L,
04-23-14;07:56AM;
C' of
Flirt Collins
P
;970-'484`-4448 # 9/ 15
Planning, Development &Transportation
281 N. College Ave P.O. Box 580_
Fart Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑"Air Conditioning
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 13,Gas Log
❑ Heating Unit ❑ Lawn Sprinkler d Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ater Heater. ❑ Water Line ❑ Wood/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 1+02271 Date 'y"oil— I
For offlo se only
Job Site Address required)e
•
Value of Construction (labor, materials, profit)
00
i ►'
� 80
Property Owner Na a Address
,City/State Zip
Phone
gS..
y
Applicant Na'Address
Gty/State 7Jp l
Phone
rza lv 1 . L ti
ko
q7o• . g /I
ntractor Address
City/State Zip
Phone•
n e i to
8o5a
qq yg
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
Here PReport
srresrBxnw,user/�regW,edbya//wn&vcao�
f0!(a
Are you paying with your trust account?
Wes ❑ No
Is this a residential or pornmercial project? 'PResidential ❑ Commerclat
If residential, Is It: Single Family Detached C3 Condo/townhome (single family attached) ❑ Duplex
O Multifamily (apartment) 13 Garage
If commercial, Is It: 0 Bank ❑ Bar ❑ Church- ❑ Hotel/Motel E3 Medical office D Office ❑ Retell
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No lfyes, you may need to contact Historic Prasermblon
If this is for a demolition permit, what year was the building constructed?
Ifpnbr to 1975, you wl// need an asbesins assessment to submit M0 this app/icatlon.
Description of work
"If lawn sprinkler/backttow preventer, must list licensed plumber. If first-time A/C, must list licensed electriclan.
Subcontractors: Ust the comp oy name or Oty ofR Collins license #
Iilectriden Plumber MechanlCa Roofer Other
I hereby acknowledge that I have read this application and state that the above Information Is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant
Print Name: 2�n Signature,
patsy �':