HomeMy WebLinkAbout3555 STANFORD RD - APPLICATIONS - 6/14/2012Pla
City of 281 N. Cc
Flirt Collins Fort t v Jv
Phone 97
OVER-THE-COUNTER PER
This application is to be used to apply for the following permits only I
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service c
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roof /
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (mus
manufacturer).
Complete all applicable information on the application. Incomplete a
Application # r
LS 1,_;�6 (�2 Date _
For offlce use only
)ob Site Address (required) Value of Construction (labor, materials, profit)
�.�J s ✓' ftNFO1Cl� �fl-D � �oC-/ � � � (;`Crr=,
Property Owner Name
_�'OM I MZ5o,J
Address
35S Jtl!Nraro
City/State
Zip Phone
Cn BOSS °__Ic�- 11_fl
Ap li ant Name
=tF ( J/fi7rG�
Address
o/ 6)1?ZNvT
"'City/State
wIr✓JSajq C6
Zip
SOSSO
Phone
'70 < 7 Boo
Contractor
�� Lic #
/* �x6£ ACIOK D 730
Address
City/State
Zip
9 65Sa
Phone
970 -4W7 Sa
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here
or by report?
❑ Here ❑ Report
Sales tax numn is required by a# contractors.
Are you paying with your trust account?
❑ Yes ❑ No
NV/���
Is this a residential or commercial project? ❑ Residential q Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office A Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 0 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? A79 /
If prior to 1975, you will need an asbestgs assessment to submit with this application.
Description of work
E C,C S
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber
Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: ,
Print Name:�*flg�j fh IR6 Signature
Date / JO.-I v2o/Z