HomeMy WebLinkAbout419 CHUKAR CT - APPLICATIONS - 8/8/2014This application is to be used to apply for the following Permits only (check all that apply). Q Air Conditioning
❑ Demolition (interior nonstructural) O Electrical Alterstlon (not service change) 13 Gas Ughtrr 0 Gas Log
0 Heating Unit O Lawn Sprinkler O Mobile Home replacement Raofurg ❑ Sewer line ❑ Photo voltaic
0 Ventiis t7on ❑ Water Heater p Water Line 13 WoodlPellet Stove (must be EPA cartttled, provide make, model and
manufarcturer).
Complete all applicable information on the application. Incomplete appitcations will not be accepted.
Application # TS Date OS • • 2CJ I�-
For &W0tits only
Job Site Address (ieoralnsdJ
Value of Construetlon (labor, maberials, profit)
Property Owner Name Address
city/state Zlp Phone
.•C-i n VJ '�Cx
C- 9-10 -a15- yoss-
Applicant Name Address.,:-
City/State Zip Phone R-M -
AJG ,rAc&6 'Roo' Tti^c am ux Tc-ikb i2A PTt ca aaSaS a-o-7-oaoo
Gonlrat4of Address
tty/state Zip Phone
Co►ltracWr City of Pt. Collins Sales Tax 9.
Are you paying taxes here or by reporV Mere 0 Report
Gttnramfter&nDw bD1'eum�rtiauars
Are you paying with your trust account? es O No
is this a residential or ammerdal Proled7 !i Residential 0 commercial
If residential. Is It; 91 Single Famliy Detached ❑ Cbndo/tawnhoma (single family attached) 0 Duplmc
❑ Multifamily (apartmenio 0 Garage
If commercial, is it: 0 Sank O Bar ❑ Church h 0 Hotel/MoW 0 Medical office 17 Office ❑ Retail
❑ Restaurant E3 Other (explain)
Ts this building So years of age or more? O Yes O No jF'M you rnByarUad to ContatthlisG cPreserxrdlfon
if this is for a demolition permit;, what year was Cl2'bullding oanstrueted?-
rfprivrto 197 , you will naad an astrastes aswsm7 art ao submit wail+ tlr&appffa fion.
Description of work nc �- x' • r4'i r iDig
4.1 '2
*If lawn sprinider/baddkmr preventher, must @st 110ensed plumber. if flrslAme AJC, must list licensed etectrlda
Subcontractors: LWefteowpanynamaar04-arm cams RaanseA
0edrrdan,
P.....r.e. Mad+aelml rtoor� _ Other
Thereby admovAedge thati have reed this application and state ftt the above Inferrnation Is complete and correct 1 agree to
comply with all requbement+contafned herein and city ordinances rfnd state laws regulating building construction. I know that a
permit IS not valid until It has been paid and Issued.
t '
t�; `�
pppllcans' A /ft S signs %K'e ��
PrintPlame' Fi �