HomeMy WebLinkAbout1133 BENT TREE CT - APPLICATIONS - 10/3/2014� 6y lle�tiY�`8 S"BiG��I'C�&99®� 1�tYA � �v!!F®9Y,Tgl;I B a'�t'�ltU`®dt. b:
This application is tQ be used to apply,for the following permits only (check all that apply), p Air. Conditioning
O•DemollObn (Interior non-sb ucturaD '0Eectri631 Attwaltoa (notseniice change) ❑ Gas Lighter ❑ Gas Lag
Q beating Unit O Lawn Sprinkler O Mobile Home reptacemanl: )fRoo6,q . -O Sewer Llne n Photavoitafo
U Ventilation .Q Water Hegies,13 Water Line Q Wcodlf llet Stove (must be EPA ielViad provide maka, model and:
manufacturer).
Complate all applicable Information an the application_ Incomplete applications Will not be accepted, .
Application �I�'%f��aJS,� Pate��U%
Fora e wv.Rrlfy
Sob Site Address (required)
Value of Construction (labor,,matertata;• pron*
:..
` O b
Property Owpw Name Address
Cityxtate Zip
Phone
Applicant Name' Address..
'Cdy/SYate. Zip.:
Phone q-M'-
�-F �o�bte "�o� � v+t _ 2t lei CJ_ Te5 i� Rc� . C—'T"C .. C� . $oS,� S•
. ,�0?-06o a:
Confracmr • Address
divistate rip
Phone
Contradvr CIi:Y of Ft.:Collins Sales.Taz 9
Am *paying twws het a or by repwtT. el na a Report
'streF larmrmbe braquuedbye#c=&ertcr•
Are you paying with your bust account?
O'NO
sthis;a res;dofti orcomTnmt l pmject2 l7Regdentiai- O Commercial
If residQnifal, is It: • IM�Smgle Famliy DetaChed L]tondo/tatartllome.;(sirkgle family aliaiited} D ihfsilerc
Q Multifamily (apartment) O Garage
Ifwmmerdai -&IG �O Bank' O Bar O Church` ❑ Hole Mbtel ❑ Nlediosloffiae ❑;dfiice,:.U'Ref$l,
a Restaurant 0 other (e gbfn)
Is tlrts bslflding SQ years of eege er mane? C1 Yes a No IPy2 ynu.rnaVhead fq*mutlartmafwftpres� Dbn,,,
If this is _roc a de,noiition ves'1t4t, what yew. was thf -loulding'canslruc�d?•
Ifaufcrm;i971, you rvlp nead'an asbFsdos anent m srrnrrrittnadi ittts epy�&caiion..
*if lawn ortnlderibaddlow:preventer, must iist.licensed plumber. If nMMm6NCC mustU9t l6oensed ele�dan5
SubtonhVetom ihtdfie cmnpanynams' arC afFYCollirfslktvtsa �e
FJectriden Plumber Medianea4 �RcOer R �MfcV Chher
I herebyadaroviledge that I have read this applicatten and state that the above rnlhrmatlon Is complete WW correct: "I agree to
comply oath all requiremarts cmwlned h6vn -and M wdlnanced aril state laws regulating building aonstivcllon. t3 imowthet a
perntitIS notvalid until it has been paid and issued.
Print Name; A S y-Ipnatu(e