HomeMy WebLinkAbout4512 GOSHAWK DR - APPLICATIONS - 8/12/2014This application Is to be used to apply for the follow4ng permits only (check all that apply). ❑ Air Conditioning
❑ Qemolftion (ulterior non-strucWiai) O Eleatdcal Altemdon (notservlm&arge) O Gas Lighter O Cses Log
0 Healing Unit ❑ Lawn Sprinkler 0 Mobile Hoare replacement )KRoofing ❑ Sewt:r.Llne ❑ Photo-voltela
Ll Veniilailon ❑ Mier Beater ❑ Water line Q bVood/Pellat MMM (rnuidbe EPA certiHad, pratiide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications vd111 not be accepted.
Application # I q-�(-e I Date
Faraffrce cue only
Job Site Address Ovifted)
Value of Construclilon (labor, materials, profit)
I aw
r. 600 so
Property Owner Name
Address City/State lip Phone
3ti 4eirej Alkiet)
-5) ► t9 -1- 4-i -in
Applicant Name
Address,. QV/State Zip Phone R-tid-
-A4- orAoJok Rda 2 inc LL). Tri l% I [-' [� Cd M58- 2-0'7-e 470 0
Contractor
Address dWState Zip Phone
Contr=r City of Ft Collins Sales 1'ex t. Are you paying t mm here of by reparV I�ye 0 Report
saresrarruemDeftr�eprrtledbye+Umnrrscras
Are you paying with your trust amount? Yes 0 No
Is this a residential or commerdai project? IQ ReddeMal O Commercial
If resldentlal, is !t: VISingle Famlly Detached Cl Condoliawnhome (singie family attached) 0 Duplex
• Multifamily (apartment) 13 Garage
If eommercW, is it! 0 Bank ❑ Bar ❑ Church 0 HotellMot d 13 Medical Office ❑ Office ❑ RemB
p Restaurant 17 00w (explain)
Is this building 5o years of age or more? a Yes 17 No b`yesY ytwmayneW to mrri�ithY3YoricP25arveffan
If this is far a demalblon permit: %ttatyear was thF-buildirg eonsbrdcbed4 .
Pf vrto 197-S ytw wh7nead'an asbastm assessment W m mitvft !SVSAROWffvn.
Oesaipt4on of work +. r a . s4-i o'e i'try
L i
e
*%f lawn aWnlrlerlbaddtow prevertter, must list noerrasd Plumber. If nrst: aims Alt, must list riaensed elEtWdbn.
Subcontractors:- &ftcorrFnynan+e6'CWO`OTCW&VAteam0
9ecb[dert... Plumbs rtedurfcal tloorer F.- l $S9 Other
I hereby admowled8athat I have read this applIcation and stets thatthe above M bnmlion is complete and coned. S agree to
comply wuh all requirements conlolned hczer-n and cW ordinances end State laws r'gulating buffdtng coMuctlon. Y knowdhet a
permit is notvalid until it has been paid and issued. '
Appnonb A m �etnK t S S4gnaasr`n '1"� `� Date
print Nam n �'�.