HomeMy WebLinkAbout612 MARIGOLD LN - APPLICATIONS - 7/7/2014 (2)Planning, Development & Transportation .
City
of I � r� 281 N. College Ave P.O. Box 580
For ` Collins 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). I Air Conditioning
remolition (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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appMn�fp�`ation on the application. Incomplete applications ^wtill not be accepted.
Application # 7 d ���p Date "� ` `�
For offrce use only d 7 thD fS A5' AW-Uar, ,Z 200 13'
Job Site Address (required)
Value of Construction (labor, materials, profit)
6gr*& `90 t -in S
W2, 00 -160 o W
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g
Property Owner Name
Address City/State
Zip
Phone
A X0 I
1561 w Si S i
86
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Applicant Name
Address City/State
Zip
Phone
NA"/ 4 , I' (ECG
2A I we��-j 5�1_
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Contractor
Address City/State
Zip
Phone
Contractor City of R. Collins Sales Tax # .
sal staxu beris quiredbyall contactors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? 5
If residential, is it: ;0 Single Family Detached
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage ,
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Q Restaurant ❑ other (explain)
Is this building SO years of age or more? ❑ Yes grNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior 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: List the company name or City of Ft Collins license # A
r
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-
Print
'j
Print Name: b& if) IJA �nl Signature Date