HomeMy WebLinkAbout4261 MCMURRY AVE - APPLICATIONS - 8/28/2014City. Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F(5rt Cotfi s Fort Collins, CO 80524
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 (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ElLawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line Cl Photo -voltaic
❑ Ventilation Q 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.
Appfication # �ALkO30l�� Date '�51251/`i
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Var:e of Co-Sr._�on-(labor, materials, profit)
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Property Owner Name
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Address
City/State Zp
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Applicant Name``
Address
City/State Zip
Phone
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Contractor Lc #
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Address
city/State Zip
Phone
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Contra or City of Ft. Cod ns Sales Tax
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Are you paying taxes here or by report? 21'Here ❑ Report
Sa/estax number & required byall mn&actr-.
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Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ."Residential ❑ Commercial
If residential, is it: P Smgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Balk ❑ Bar ❑ Church ❑ Hotal/Motel ❑ Medical office ❑ Office ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building 50 years oflage or more? ❑ Yes M! No if yes, you may need to confacfHistoric Preseruatrbn
If this is for a demolition permit, what year was the building constructed?
Yprior to 1975, you wi// need an asbestos am-essment to submit with this application.
Description of work
kIf lawn sprinkler/bacclow
Subcontractors: Ust the 4
:lectridan
hereby aeknowledge that I
n tply with all requirements
)ermit is not valid until it
must list licensed plumber. If first-time A/c, must list licensed electrician.
name or City of Fr Collins license e
Mechanical Rcofar Other -
read this application and state that the above information is complete and correct. I agree to
ained herein and city ordinances and state laws regulating building construction. I know that a
been paid and issued.
applicant: `' ���� \
'rintName: L�n-AA l ra Ati1`- Signature-_1 ay Date
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