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HomeMy WebLinkAbout1148 EVENSTAR CT - APPLICATIONS - 4/2/2012CI Of Planning, Development & Transportation 281 N. College Ave P.O. Box 580 ®r� Collins Fort Collins, CO 80524 Phone 970-41616-2740740 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 ❑ WaterHeater ❑ 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 #. For ofte use only Date q-2 —/A Job Site Address (required) Value of Construction (labor, materials, profit) . i t IS'y $ y 000 PropertyOwner Name Address City/State Zip Phone Al rgg?, y4gpia% o5 aR I - o G Applicant Name Address City/State Zip Phone Contractor Uc # R- 17 8 3 Address city/State Zip Phone k,ckY F.'V" rra,'v R00fe2l 4T1 1. 4')k (tj AIin'Cr CV11"v1 LD � + 02.o2.'f—tod00 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 19 Report Sales tax numberisregroredbyall aw&actum Are you paying with your trust account? A Yes ❑ No 413?0 Is this a residential or commercial project? IgResidential _❑ Commercial If residential, is it: ❑ Single Family Detached �R Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes A No if yes, you may need to contact Historic Presenabon If this is for a demolition permit, what year was the building constructed? If prior to 1975, you MY need an asbestos a_,w�nt to submit with this applicaton. Description Qf work 19MF c lc�. :Tfoz.4101115 AIurnbe 2 D I@„atef *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 license # pL? p Irod Roc T i''U s Electridan Plumber Mechanical Roofer Q- 1 `% 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: Print Name: Jo `J F 2 4 C1C Signature Date 04/02/2012 14:45 19702241211 ROCKY MTN ROOFERS PAGE 05/06 City.of Planning, Development 8F Transportation 281 N. College Ave P.O. Sax 580 F&Collins Fbit Collins, 00 80524 Mione 970-416-2740 Fax 224-6134 OVEWTHE-COUNTER PERMITS ONLY This application Is to be used to apply for the following permrfa only (check.all that apply). 0 Air Conditioning © Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit El Lawn Sprinkler Cl Mobile Home replacement 9�-Roofng !3 Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water -Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete AN applicable Information on the application. Incomplete applications will not be accepted. Application #, For offlae Lw ony Date 11 2 —14 -- Job Site Address (r ) Value of domstrwbon (tabor, materials, profit) i L• i y oo� prope`� Owne Name Address City/State Zip Phone fl n6 C� b' 22— o D Applicant Name Address City/Rate zip Phone Coroaecor Uc #A- n783 Address Gty/State Zip Phone f�rckY ,,, ��rRr� ,ecefa�f ,Iry 1.4� CtJ Fmx-r CothvY co B&.rA au-4--Idon COnt aCtOr City of FL Collins Sales Tax # Are you paying taxes here or by report? 11 Here 9 Report S sta�rrnm+t rsr redbr�mrmact Are you paying with your trust a000unt?,W Yes ❑ No *f 9 T7 kr Is this a residential or commercial Project? J9R _17 CamrneFc1a1 If residential, is it: C) stngte Family Detached IRCondo/townhome (single family attached) ❑ Duplex ❑ Miulftinily (aparbrent) © Garage If commercial, is it ❑ Bank © Bar ❑ church ❑ HotWMotal 0 Medical office ❑ Office ❑ Retail © Restaurant C] other (expaln) is this building SO years of age or more? ❑ Yes JANo If yps, yrar, may need m mnG1d ferric Rvalion If this is for a dernord ion permit, what year was the building oansbuded7 1fprfor to 194 you w1# need an asbesW5 awessaent to submit wr7h d& app n. D�iption qf wotic� +4 TU _ Dt,us�d-io+a A/vmioe 2 4 .7&um4e *If lawn spnnkW/bad6tow prevanter, musk list licens ed plumber. If first- irre A/C, must list fcer'S,.,ed ele+ct)"Om. Subconbactorin Li5t Me cufnpaW aww or Cly oFff C&ffns hawkse 0 ()tK?►.�o t ti+tiy eaculdan. r Rooft 2 - 1 '7 3 Other. I hereby =WwwW1ge thak I have Head Ow apptic adon and stake that the above mfor� is omnplete and correct. I agree to comply with an requirerra is cmYolned herein and city ordinances and stab laws regulating bolding eonsbuction. I know that a perink Is not valid until it has been paid and Issued. Appfimlb Print �o `"► i�2 rt tk sigraeture