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HomeMy WebLinkAbout4454 HOLLYHOCK ST - APPLICATIONS - 8/14/2014Q.Ixy. of F®r Planning ®ever® ®��� � Irin 281 N. College Ave Pent 8t Transportation Fort Collins, CO 80524 O' sox 580 �Q 0 Phone 970-416-2740 Fax 224-6134 This application is 4* be used to a 1��ll NTER ��� ���� Cl Demolition (interior non-structural)apply for the following ❑ Heating Unit ❑ Electrical Alteration Permits ser only (han (check all that apply). 0 Lawn Sprinkler O Mobile Home replacement Pp Y)' 0 Air Conditioning Ventilation ❑Water PJe^�ter 9) O Gas Lighter ❑Gas Log manufacturer). Water Line v Wood/pellet Stove mush be 13 certified,we [j Photo -voltaic Complete all appllc+st trDf®rmation on the a Provide make. model and `/, / O &Q (0 application. Incomplete a�splications will not be accepted. Application # `-f_ l t For office use only _ - dale 'f / l q lob Site Addm ^ _ (repaired) Property Oviner Name Applicant tame Contractor Address Address Plague aT Construction (labor, materials, profit) 5a eA City/SYat Zip 450� Zc/ Phone q iG 9UcNyis U City/state y(Z z�a Zip Phone Lic Address ao() ',--> : ---` - ---- jj CitY/State Zip IContractor City of Ft. Collins Sales Tax # Saks WX numbers required 6y all contractors: A,l1 r Are you paying taxes here or by report? Are you paying with your trust account? Phone Q Here ❑ Report ❑ Yes Gk No Is this a residential or o�triercial project? ReLI� Sidentiall ®Co If residential, is it; $Ingle Family Demmercial tached ® Condo/townhome (single family attached) 0 Du lex 13 fUuitifamily (apartment) ® Garage P If commercial, is it: Bank ® gar ❑ Church 0 Hotel/Motel p Medical office ® Office 0 Retail iA RP` urant ® Other (explain) Is this build!og 30 V&SIM QG a9% or more? ❑ Yes O No If es If this IS f04' a 4�C6ddmIgQ1®W imrarmit, what year was the building onsttrructed�y n td con —tact Historic Preservation If prior to 1975,.; mu wili need an asbestos assessment to submit with this app/icati®n. Description of work c- *If lawn sprinkler/badolow preventer, must list licensed Plumber. Iffirst time A/C, must list licensed electrician. Sub�ntrar W© ist ?he crmoany name or City of Ft Coffins license 4' Electrician______ Plumb(� ` _er Mechanical_ Roofer k 200% Other_ I hereby acknowledge thW' S have read this application and state that the above information is complete and correct. I agree to comply with all require-nents contained herein and city ordinances and state laws regulating building construction. I know that a Permit Is not valid uneil it has been Paid and Issued. Applicant: \\ d Print N aere signature ,. — — z-�--- __ gnataure _� J Lx Date