HomeMy WebLinkAbout6107 PHEASANT CT - APPLICATIONS - 4/2/2012APr. 2. 2012 10:49AM Bob B e h r e n d s Roofing
No-6763 P. 3
aty ofum
...
1.1
pfaurring, Development $ Transportation
281N. College Ave P:O. &k 58().
Fort Collins, CO 80524
�9 Phone 970-416-2740 Fax 224-6134
®11>EIR-THEE-COUNTER PEIRMITS ONLY
This application is to be us&I!
tO apply for the ❑ Demolition (interior non-striutural) 0 Electrical Alteratng ion (not service change) all that apply). ❑Air Conditionin
ts Y (. pP y)-
❑ Heating Unit O Lawn Spriafcler. O Mobile Home replacement g) la Gas Lighter ❑ Gas Log g
17 Ventilation d Water Heater , )(Roofing O Sewer Line ❑ Photo -voltaic
manufacturer). Water Line ❑ Wood/pellet Stove {must be EPA certified, provide make,.model and
Complete all applicable infceanation on the application. Incomplete applications w71 not be accepted.
Application # ((USX
For office ccSe 4W — 'Date a a.
Job Site Address (requlrad)
�°\ b-\ C
Property owner Name
Address
c
Applicant Name Address
Contractor ° L.ic #
_ •Address
Contractor City of Ft. Collins &A Tax #
Saes 4Zr/7UM Nris requirzd byar =aaCt=.
Value of Constr.vcuon (labor, materials, profit)
City/State Z'ip Phone
City/State J
�P% Phone
«.t ob3 'fig s- a
City/S to Zip Phone
S1 s- 040
Are you paying taxes here or by re
cl
Are you paying with your trust account? Yese ClNo Report
Is this a residential or commerdi-project?
If residential; is it; i —�R esidendal ❑ Commercial
n0eBmily Detached ❑ Condo/townhome(Single family attached) MuWaWy (apartment) ❑Garage
O Duplex
If commercial, is it: ❑ Bank Ili Bar q Church ❑ Hotel/Motel ❑ Medical office ❑Office ❑ Retail
Is this building 5l3 years ��� 13 Otter (explain)
If this Is for a demolition 9 more? d Yes �No If yes, you may need in ct7ntact y;dc preservation Ifprior to J975 ' k what year was the wilding constructed?
you wi//need avas/ae amassment In subm/t w/th this app/icahan,
utrscripaon or work c. S b F4 A
*If lawn sprinkler/backfl w reveffer, P ,must list licensed plumber. If first-time ~
S+t"tractors. "It the �,cwYname or Gty ofFt Co//ins/icensfir ' m list licensed electrician.
ust
Electrician, Pl unilp-, McManical
—�� Roofer .,. �� Other
-�� + +wveaeao this application and state that the above information is complete and correct I agree to
comply with ail requirements has3 ed herein and city ordinances acid state laws regulating building construction. 3 lrnovi that a
Permit is not valid ttntif at �as3sen paid and issued.
Applicant. ,
Prsnt
5ignatare `1
® Data