HomeMy WebLinkAbout421 E SWALLOW RD - APPLICATIONS - 1/5/2012C3o3- y;1-0 -098tp
' City of Planning, Development & Transportation
^tt�� 281 N. College Ave P.O. Box 580
�t Collins Fort 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 ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler C1 Mobile Horne replacement ' -Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater O 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 #, L2>12ac��
000S3 Date 1 � O),� �_ 1
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Pro Owner_Name Address
City/State Zip .
Phone q
rU(+1ftMMh( E
\�UZ E G
A licant Name Address
City/State Zip
Phone
\
oniraCor Lit # Address
City/State 7rp_
Phone 3-
-
4om0-
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Co ctor City of R. Colli s Sales?Tax #
Are you paying taxes here or by report? `.•Here
❑ Report
5a/estax numberls1equiredbyaamneadom
Are you paying with your trust accobnt? ❑ Yes.
1 No .
is this a residential or commercial project? II -Residential. ❑ Commercial
If residential, is it It Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment). ❑ Garage
If commercial, is lt: ❑ Bank .0 Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 'fill No lfyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this appllcad'on.
of
*If lawn sprinkler/badc`iow preventer, must lint licensed plumber. If first-time A/C, must lis< licensed electrician.
Subcontractors: List the company name or Gly offt Collins /!tense 4
Electrician Plumber
Mechanical 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 reciuleements 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: r\rtM�c - - /�, - /, �1
Print Name 1�I YItIIG Signature��1 ��_ Date ti V� D,