HomeMy WebLinkAbout804 ALTA VISTA ST - APPLICATIONS - 9/12/2011Sep 12 2011 11:12AM HP LASERJET FAX
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OVER-THEmCOUN'T'ER
Pbnnln& 0gveiopment S Transportation
-201 N. C1011ege AVe P.O. Box $80
Fort Collins, CO 80S24
Phone 970-416-2740 Fax 224-6134
PERMIT- ONLY t5�7�
This appllafloii Is to be used to apply for the following Pwmh�s Only (oheok all that
O Demolition (Inlerior non•structurso ❑ Electrical Alte►adon (not } change) p Opa y OpAIOas og
fining
O Heating Unit 0 Lawn gprinlger O Mobile Home replacement VRooflnp O �yygr Line O Photo -voltaic
m Ventilation 0 Water Heater Water Llne ❑ Wood/Pellet stove (must be EPA certified, Provide make,
manufacturer), Idde and
complete all appiloa e ( rrrtetl on the applioetian. Inoomplels appNost4...e
Application* I V� will not be aooe
hr err envy Oahe , � �. (%i
lob Site Address (mm-ew
ProPerty Owner Name
Applicant Name
Conts"r Lk #241
Contractor CRY of 11L Collins Sales Tax #
Sr/rrr a w wMil arlrrpl *W by_aA' C&7&+a&s
Value of ConsWuWon (labor,
$ 5046 -7 in .1.0
Address City/Sta,,te� �. ZIP fo�Phone
V---A s :E r �. �1�. 43Q�71.� 3US
Address
City/Staft Zip Phone
Address City/state Zlp Phone
Are you paying taxes hens or by report? M Here O Report
Are you paying with your trust account? 0 Yes Gh No
Is this a residential or al project? dendal O Corrrnergal
If reslderfdal, Is it: [$ Slrgle Femdy Detached O Condo/townhome (single family attached) O Duplex
0 Multifamily (aparbnent) E3 Garage
If commercial, IS It:..l] Bank 13 Bar O Church Q Hotei/Mobai .O Medkal oinoe ® Office d-Retail
G Restaurant - O Other (explain)
Is this building 6111years crags or morel O Yes D No 1fM pc v flay r eed to cnvelyd HA*v& Pr6S&V~
If this Is for a demolition parnrh>;, what year was the building consouctev
Jrprbr [e r97S,, few will naiad an asbasw went to SU47W w*r ow 4op/ktftw
Of
*If lawn sprinkWAKIdlow Praventer, must fist licensed plumber. If first -URIC AICV MM list licensed electrician.
0
Subcontracion: Lht s!e conipmy rime or Oty of At Cbev lkaw ,e
6edrldan Plumber MWenlcal ROOAer . Other
I hereby adrnowWpe that 1 have read dhls application and state diet the above Information Is complaft end correct I agree to
comply with all requirarnatt mined herein and city ordinencas and state laws regulating building consbuction. I know that a
permit la not valid until It has been paid and Issued.
Applies
Print Nun: _ Sgnatyre
Date l (24/ .( I