HomeMy WebLinkAbout4112 WARBLER DR - APPLICATIONS - 8/10/2014�i City,
f Planning, Development & Transportation
281 N. n V1 {� CoWns Fort Collins' CD 80524ge Ave .0. Sox 580
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 (cheek all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) 13 Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
ID Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement .4rkoofing ❑ Sewer Line 0 Photo -voltaic
0 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 accepted.
Application # 23140 57171
Forolhe use only
Date eAO-"Z"L,
Job Site Address (rerlulreq
J zV
Value of Co CtiOn (iaborr matey 10 (profit)
Ltjt�
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Properly Owner Name Address
Oty/State
Zip
Phone CO 0-
X54 2�4A G5- WeleeLrte-T(
]Pk C.') L. Co
20S2G
2t`1-333i
Applicant Name .Address
•D►•
City/State
Zip
Phone
4£eTS�X WY {�Jw>,+av►r�J
(I.W. Co.
9052L
"0'45B-0seq
Contractor Address
City/state
Zip
Phone
Corrtractor City of FL Collins Sales Tax #
Saw mzn ffrbwis fSrbyaff wn&ad= Are you paying with your trust account?
KYes ❑ No
� S2rw
Is this a residential or commercial project? 07Residential ❑ Commercial
If residential, Is It C1CSingle Famiy Detached ❑ Cor►do/toamhome (single family attached) ❑ Duplex
0 Multifamily (apartment) 0 Garage
If commercial, is It 0 Bank 0 Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) r
Is this building 50 years of age or more? D Yes tgNo If yes, you may need to mnaxt HUD* Preservation
If this is for a demolition permit, what year was the building aonsbuched?
D'prlor to 1975; you wll/ need an aunt agent to svbm/t WM MIS application.
CTj
*If lawn sprinlder/baddlow prevenba, must Iist Hoehsed plumber. If tirsEtlrtrr?hJC, must fist lioensed electrician.
Suboantractora+ Ust ffie company name or Uty of Ft CoMbs keim 0
Plumrw. Medwdcal Roofer.. R,- B J ! other
I hereby admo~ that I have read this application and state that the above Information Is Complebe and correct. I agree to
canpy with all reQuftnents contained herein and city ordinances and•state laws regulating building won. I know that a
permit is not valid until It has beery paid and Issued. _
Applicant"�C � XTOh
PPrinttHama: I
Date Q 40 - N