HomeMy WebLinkAbout901 BITTERBRUSH LN - APPLICATIONS - 10/3/2014This application to to be used to apply for the following permits only Mack ali that apply) O,Air Cond{tionntg `
11 Demolition (EnWor noirstructurat) O EleLt caE A iteration (notservioe changej.. O Gas laghioar'Cf Oas Lcq
Q Heating Unit 0 Lawn Spdnlder O Mobile Home replacement )9 Roofing O Sewer Line: O Photo-roliele
C+ Ventilation ❑ Water Heator O vaster Line ❑ WoodlPeffet Stove (must be EPA ceiffied, provide maies, model and
manufsieturer).
ComplOto ail 80PI10111310 Information on the appiiceBon. incomplate applications wilt not be aceeptod.
Application
Date
For off4wtwonly
Job Site Address (twuhadj
Value of CanstrpcHort (labor, proir�')
G O 1 ; r
$1 A U C)
Pra arty Owt}er Name Address
atylst ete', ZIP
Phone
App11®ntName Address
Oty/slate ZEP.
Rhone q-00-
A4 vAoa166 ,,.pd4 1 2 a l
CJ_ Tri b TLdQ P rC CG
Conbmftr Address
w zip
Phone
Contractor City of Ft. Coll[ns Sates Tare
Ara you paying taxes;I> m or by report?;(
0 Report
58fCSlav►wmDerlsreepu(re?byrlr mnoaeYwsc
Are you paying wdth your trust account? U3' e—
❑ NO
is this a residential ar amnmwaal pmjeW • ETReMentral Q Cmnmerdei
If residential, Is It, 01 Single Pamily Detached E3 Condo/townhome (angle family attached) 0 Duplex
Q muluilimriy (apartment) 0 Gauge
If commensal, is Et Q Sank 13Bar ❑ Churn► ❑ Hotel/Motel 0 Medical oBEw :U Office
en-•Q-Retail
❑ Restaurant Q Other (explain)
is this buiiding BQ years of age or more? O Yes O No B yet younnayneed to carrisctlftWcAfervahbir
If this is far a demolition perAd% whatyear was thd-bulldins consbricbed3--
D°pvfore� 197�Yev tiiill naed�n asbasmsasa�nf�rrms+vfimit wttf, thtsappll�On
Description of work 4- e` i r"H i rw.i '1n t
- i T't"
Kcx1-A is
I
*H lawn sprinlderllbacidlary pmverfter, must Ust Rtensed plumber. If firstAlme A/C, must He ilomsed elecmai n.
Subcontractars:dbtdlrc�rnpanyaamcarQ aiRCafihslr�arrseJC
5rryician P&mber. Medal Roarer R ISSq Other
r hereby admmviedge that l have read this appikation and State ffmt the above Wbrms!!or( IS tomplele aiid cmTQrk I agree to
camply wIIjr all requlrementseontained herein and dty ordlnanaes $nd gate Yaws regulating building combuQton. i tmowthat o
parmlt Is notvalid until It has been paid and issued. r
1 riplicantc inr'
tName; PrYv► 'Selnv►l S SignatuCe '�^ C
44
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