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HomeMy WebLinkAbout418 STARLING ST - APPLICATIONS - 8/5/2014This application Is to be used to apply for the following -permits only (check all that apply). 0 Air Condluoning ❑ Demolition OnWor nonstructural) © Hlectdcal Alteration (not service change) ❑ Gas Lighter Q Gas laog 13 Heating Unit D Lawn Sprinkler 0 Mobile Home replacement � Roofing 13 Sower Line ❑ Photo-vollaic 0 Ventilation ❑ Water Heater ❑ Water Line E3 Wood/Pei!et Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable Information on the application. Incomplete applications will not be accepted. Application # IsM�134 Date OB•0 • 2D�� Jab Site Address (repul2d) Value of Construction (labor, maierists, profit) 1 7 bV Property Owner Name Address City/State rip Phone 7- b.ti-, n 5 9 I - 31 - {n 4D 1. a Applicant Name Address aty/State Zip Phone q fa - A44,aosb% loa'q21•ic 2t t W. '(^r7lb Ctc� G C!3 9-0-7-ado0 i,,oniractn„r Address /state ZIP Phone Contactor City of Ft. co!itns Sates Tax g. Are you Raying taxes here or by report? e1ierel 0 RePart bust asmunCt WYes 0No swesraxnumbrrtrrv4L dbyORV=nacmrx. Are you paying with u4t is this a residential or eammerdal Project? iff Residential Q Commardal IF reMdentlat; Is It: Single a Family ❑ Garage awn {single lenity attached} 171]uplax If commerdral, is It: ❑ Bank l3 Bar ❑ Church ❑ Hotel/Motel ❑ medical omor L7 divoe L1 Remit CI Restaurant 13 Other (explain) is" building 50 years of age or morel Oyes CI No Ifyes, jW may need iv,=t6aHTsrarfC Presarvabbn If this is for a demolition psrynit, what year was did -building oonstrd&d4- Ifpravrm 1975, You v,111 need an asbestos assessment ib subv"'rm & thls4AvJtab'M *If fawn VrInkier/bad6!ow pn vim, must list lioarimd plumber. IF first: -time AX, must list ficssed elecUlclan, Subcontmdzrw. List the compeny acme or04Kof'Ft 07SAF fcsaw A oactrtria�_._--- Plumber _ Medharu®t Rooftr R' (8s9 Mer. I hereby acknowledge that I have read this app!ltation and state that the above information Is complete and cornett. I agree to comply with all rmmquirements contained herein and aty ordinances and state laws regulating building aonstructlon_ I know that a permit is rwtvaild until it has been paid and issued. ! PrintNrttt A rK� Swt� t KA 5 SlgnatureM1� T Print Name* li .