HomeMy WebLinkAbout601 JUSTICE DR - APPLICATIONS - 1/12/2012Jan 13 12 12:14p Air Masters LLC
9705322006 p.2
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation i Water 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 # 6)U0 2JUL Date J ba,z / bA /I n
Fnr nfi7rP lice nn1V J ,
ddress(required)
lob Site Address (required)
Value of Construction (labor, materials, profit)
/VVD/,
/1Cies(�, u/
Property Owner Name Address
Shy-S CLC V✓
City/State i Zip Phone 2-2 C3
7 ? (.L�li2 Car C`O �Gi� 3" � r, ��2
6�
Applicant Name Address
City/State Zip Phone
S: tI
Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?Here ❑ Report
Are you paying with your trust account? Yes ❑ No
Sales tax,irenberis /red by all cml actors.
H -142% 4
Is this a residential or commercial project? W Resic
If residential, is it: 'Single Family Detached ❑
❑ Multifamily (apartment) ❑
if commercial, is it: ❑ Bank ❑ Bar 0 Church ❑
entiaf ❑ Commercial
Condo/townhome (single family attached) ❑ Duplex
Garage
Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes VLNo Ifyes, you mayneed 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 apPlicadon.
Description of work ✓C t' ha2ki' P'l�G'le'w-&yy l^f
*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time A/c, must nst ircensea eLecu1c1rn1.
Subcontractors: List the company name or City of ft Collins license #
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 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. e \
I
Applicant: (6 Date
Print Name: / j t, \ � U[ Pj Signatu —