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HomeMy WebLinkAbout4553 SEAWAY CIR - APPLICATIONS - 8/28/201408-26-'14 07:59 FROM -Premier Hoofing 9704848308 T-212 P0002/0002 F-428 . Cityof manning, UOY0mpmea4,a INanapauu mry 281 N. College Ave P.O. Box580 al"t Call�n5 Fort Collins, CO BD524 Phone 970-4lR740 Fax 224.6134 aL OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning Q Demolition (interior non-structural) Q Electrical Alteration (not service change) 0 Gas Lighter Q Gas Log 13 Heeling Unit O Lawn Sprinkler 0 Mobile Home replacement 0 Roofing A Sewer Line Q Photo-voltalc O Ventilation Q Water Heater 13 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 # "-f 0 l 2 Date 8 �K l,orof9ce use only Sob Site Address (rieguir4 (. Valpe of Constntttilon (labor, materials, proflt (� Q P&WO- Property Owner Name Address city/State Zip Phone S .ha oeh, Applicant Name oar, n a rural lb Address City/State Zip Phone Contractor t?.f'ritPif' .14DI Address u-Q%Ui City/state Zip Phone SLQ! 23 Contractor 0ty of Ft. Cti ins Sales Tax # Are you paying taxes here or by report? 191ere 0 Report Sales tax number Isregrdredbyall conbuftw, Are you paying with your trust account? 1] Yes ❑ No Is this a residential or to erdal prglect? L9'Resldentlal O Commercial If residential, is it: Ingle Family Detached Condo/townhome (stngie family attached) ❑ Duplex © Multifamily (apartment) 13 Garage �. If commercial, is it: 13 Bank 0 Bar ❑ Church 0 Hotel/Motel 15 Medical office 13 Office 0 Retail 0 Restaurant 0 Other (explain), Is this building 50 years of age or more? Q Yes 04F Afyes, Wu- maynw0awntact&&1icprrjww#an If this Is for a demolition permit, what year was the building constructed? Ypr/orto 1975 you will need an asbas0sassessmeni'tosubm/tw1th n5isappl/ca#on. Of *If lawn sprinkler/baddiow preventeq must list licensed plumber. If first-time AX, must last licensed etectrkian. Subcontractors:L(stlheaompanyoameorLYlyofFtCb//Ins/lrens� Electridan plumber. Mechanical Rader Other I hereby acknowledge that I have read this application and state that the above Information iscomplete and correct, I agree to Comply, with all requirements contained herein and city ordinances and state laws regulating buildUiy construction. l know that a permit is not valid until It has been paid and issued. Applicant: Print Name;! J 51 bo n T Signature Date 0<3 ;5LCp I )