HomeMy WebLinkAbout1133 BENT TREE CT - APPLICATIONS - 7/28/2014 (6)FROM :NCA
FAX NO. :9702299983 Jul. 28 2014 10:46AM P10/10
City of
'e Cairns
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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). 1Air Conditioning
F❑ emolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler 17 Mobile Home replacement O Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation ❑ Water Heater ❑ 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 J, accepted.
Application # J+04-101 Date T—
For ofiee use only
Job Site Address (required)
Owner Name
Applicant Name
Contractor
Contractor City of R. Collins Sales Tax #
sales tax number Isrequ/fed by ap conbadam,
1
ca � L41 ............,..
value of Construction (labor, materials, profit)
...._ kd a=- 211.5-
Address City/State Zip Phone
Address City/State Zip Phone
Address City/State f--+ %Y1CZIp Phone cl.'! "a
Are you paying taxes here or by report? boere ❑ Report
Are you paying with your trust account? Yes ❑ No
Is this a residential o4slultifamily
mercial project? Residential ❑ commercial
If residential, is it: ngle Family Detached ❑Condo/townhome (single family attached) L7 Duplex
(apartment) ❑ Garage
If commercial,.is it: CI Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (eYebuilding
)
Is this building 80 years of age or more? Dyes
o If yes, you may need to contact Historic Pneservatlon
If this Is for a demolition permit, what year was constructed?
If prior to 1979, you will need an asbestos assessment to submit Wth this appllcabon.
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 R Collins lkww #
Ekctrlclan Plumber 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:
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