HomeMy WebLinkAbout901 MILAN TERRACE - APPLICATIONS - 1/27/2012Ff20M— A�A
FAX NO. :9702299983 Jan. 27 2011 11:55AM P1
r Planning, Development & Transportation
City r1 281 N. College Ave P.O. Box 580
_! 61r'y l}ofColti 1.rFort Collins, CO 80524
n ah e n ca,8r� f- "one
97m 6-2740 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). 0 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 O Photo -voltaic
O Ventilation ❑ Water Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Informationonthe application. Incomplete applications will not be accepted.
Application # aoo 110 Date 1 -�- t (Z o2S • 00
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1 m XVA' k >c>f�c_(L
1-4 �o .
Property Owner Name
Address City/State Zip
Phone
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Applicant Name
Address City/State ZIP
V
Phone
Contractor
Address CIty/State Zip
Phone C1 _)'D
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Contractor City of Ft, Collins Sales Tax # Are you paying taxes here or by report? ❑ Here
XReport
Sales tar number Isrequ/red by allconMct&s. Are you paying with your trust account? MYes
11 No
Is this a residential or commercial project? 9. Residential ❑ Commercial
If residential, Is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
ILJ Multifamily (apartment) ❑ Garage
If commercial, is it: O Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (explain) _
Is this building 5o years of age or more? O Yes ❑ No If yes, 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 application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L'st the company name or City of Ft Collins license 4
Electnclan -9= 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.
Applicant:
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Date ' �� Z