HomeMy WebLinkAbout1133 OAKMONT CT - APPLICATIONS - 8/20/2014From: All Phase .Restoration Fax: (970) 622-2057 -To: Fax: +1 (970) 224-6134 Page 9_bf.9.08l20I2014 3:03•:', .
t ®$ planning, Development & Transportation.
tY .281.N. College Ave P D Box 580
rt aCollints.:
Fart Goilins, CQ 84524
Phone 970416 2740 Fax 224 6134 '
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This application -is to. be.used to apply fQrthe:followin permits. onl g p y (check all"ihatapply). q AIr:Condiboning
❑ De<molipon. (int@nor non-structural) fl Elecirigl AtteraGon (not service; change) p Gas Lighter ❑ Gas Log
❑ Heating Unit : 0 Lawn..Spnnkler= O Moblle;Home replacement:. Roofing D Sewer Line: Q Photo-vaita(c
q Ventlla4on ;❑ Water Heater ;q W0t1 r;Line.. q Wopd/Pellet:Stove (must.be EPA cert(ffled, provide make 'model and
manufacturer) .. ;
Complete all applicable informatipn on the application mpl7.
Incoete. applWatlons will not be accepted
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APPhcataon # l ".� . Date
Fqr once use only' ... ..
Job Site Address (required) "Value.of Co uchon (labor, materials, profit}
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/f3c�rr o n f : 3
Property. Owner Name . ": Address City/State. Zip ; Phone
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ApphcantName. Address Cary/State Ziq Phone.
7/syl »
Contractor Address City/State Zip : Phone„
73s5
Contractor City of Ft Coibns Sales Tax # Are you. paying taxes. here or by, report?,Here ❑ Report
salestarnumber/sray�a Contra " Are you paying withyour.trust account? ❑Yes No
Is this a residential or commercial. project? Residential ❑ Cgmmercial
If residential, is it:.. Single Fam11y ;Detached. p CQndo/townhpme (single family attached) ❑ [)uplex
Mulhfamily(apartment) : C7 Garage
:If cotnmerdai, is it:.. Q Bank p Bar•,13Church A Hotel/Motel..O.Medical office .:C] Office :.,❑ .Retail
L7.Restaurant : ❑Other (expialn):
Is this building So:years:of age or morel p Yes No Tf yPs, you May:need to contactHisto{tcPreservahon
If this is'.for _a demo) or permit,:what year was the building constructed?
Ifprlgr to i975,. you wl//need an asbestos assessmenCta submrt:wlth #hisapplrcatron. ` " '
Description of work
t � or eiVa,�c: shyelri. P-cS sau�+
*If lawn sprinkler/backf qw preventer; must list licensed plumber . Iffrst time A/C, must list licensed qi c rician,,
Subcontractors: W, the cernpanY.. name gr-Qyofft i*nrlicense # '
Elee3ridan_ .Plumber. Mechanical Roofer .Other.
I, hereby acknowledge that.Thave read this application and state that the above information is complete and correct. I:agme to . ,
-comply with, all.requirements contained.herem and city ordinances and state laws;regulating building construction. I kmow that;a
permit is not.valid until.lt has been 4►ald andassued.
:..'Applicant.
Pritet Name,�r " r�` Signature . Data
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