HomeMy WebLinkAbout4130 SUNSTONE DR - APPLICATIONS - 3/29/2012Mar 29 12 03:38p A J Shirk Roofing 19706695999 p.1
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�C_ ity Of OV luh� (� Planning, Development&Transportation
f1O537 281 N. CoilegeAve P.O. Box 580
�t Colons Fort Collins, CO 80524
/100 � Phone 970-416-Z740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits appp ly (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑Electrical Alteration (not sece change) ❑Gas lighter ❑Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 17 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 # V a` 01(0 � Date
For oli%r use only
Job SI
iad) 4 100 &,i->Siw e, Value of Construction (labor, materials, profit)
Property Owner Name
Add ress�tl ,/ 3o �itv/State Zip Phone
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r^fu
%C `3!� &10
Applicant Name
Address City/State Zip Phone
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Contractor
Address City/State Zip Phone
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uo-Fih Say E, 6"ST v land a SD537 6& - 999
Contractor City of Ft. Collins Sales Tax # yl 0 3 %p Are you paying takes here or by report? ❑ Here .4 Report
re
salesmxnunae-IspuredbyaaavreacWm Are you paying with your mist account?,'1 Yes Cl No
Is this a residential or commercial project? Rkesidential ❑ Commercial
If residential, is it Ingle Famity Detached ❑ Condoltownhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restawant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No 9yes, you may need to contad HisB c Pressmation
If this is for a demolition permit;, what year was the building constructed?.
Ifpnerto 1975, you will needan asbestos assessment to submit wide tars apphcatrom
Description of work 'P cf r +c, of e c c . L h sl'C, ! f O . C`, fL)y r'a
cl—h �4 f e, S Sri
n r fQ i rn , -e, 4,j en ^(C
*If lawn sprinider/backflow preventer, must.lrst Iicensed plumber. If firstfime A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins Adaise # R 1589
Electrician Plumber Medianiral Roofer �- Other
I hereby adaiowiedge that I have read this application and state'that the above information is complete and oorrect I agree to
comply with all requiremerrts contained herein and city ordinances and state taws regulating building eonsbixtion. I know that a
permit is not valid until it has been paid and issued. _
Applicarm� ,A/
Print Name: G r/r /�' �i4rV Signature
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