HomeMy WebLinkAbout3230 SILVERTHORNE DR - APPLICATIONS - 3/2/2012MAR-23-2012 08:58 From:Allen Service
of
Fort Collins
970 484 4448 To:92246134 Pa9e:5/19
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
O Demolition (interior non-structurg El Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
* Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
* Ventilation Water Heater ❑ Water Line O 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 # 01) 01 .I(3 I _
For ofnee use a*
Date. 34-1 a -
Job Site Address lrenuiredl Value of consbvction (labor, materials, profit)
a�abI,
Propertv Ow er lvarnp Address City/State 7.ir) Phone
-Lois' aatt,-�jy3
Applicant Name Address Cary/State rp Phone
sh�•rti
Contractor Address City/state Tip Phone
r vo-mm 147Ll- qg l
Contractor City of Ft. Collins Sales Tax Are you paying taxes here or by report? ❑ Here Report
Sales tax number Ir *agwred by 0contraclws Are you paying with your bust account? g Yes ❑ No
Is this a ntial or residemercial project? Residential D Commercial
If residential, is it: Single Family Deta d ❑ m
Condo/townhoe (single family attached) ❑ Duplex
❑ Iltifamily (apartment) ❑ Garage ,
If cornmercidl, is it: ❑ Bank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical office - ❑ Office C] Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes JV No 11 yes, you may need to contact Hisw& oreselvaeon
If this is for a demolition permit, what year was the building constructed?
Y prior to 1975, you will need an asbestos assessment to submit w/th this applhwhron.
Description of work _
*If lawn sprinkler/baCkFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the Company name or City of Ft Collins licensee
Electrician Plumber Mechanical RWcr Other
I hereby acknowledge that I have read this application and state that the above Wormation Is Complete and correct. I agree to
romply with all requirements contained herein and city ordinances and Kate laws regulating building construction. I know that a
permit is not valid until It has
been paid and issued.
Applicant: _ \h�rrl V(1 n 2)-01
Print Name:_.__--„ Signatur Date