HomeMy WebLinkAbout612 MORSMAN DR - APPLICATIONS - 5/30/2012City *of Planning, Development &Transportatlon
281 N. / ollege Ave
Fort Collins Fort Collins, co BOs24 P.O.
Box 580
�— Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER P'ERNIITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
G Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
M Heating Unit G Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 'Sower Line 0 Photo -voltaic
0 Ventilation G Water Heater 0 Water Line 0 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.
Application # 20 3326 Date May 30, 2012 .
For ofte use any
Job Site Address (required)
612 Morsman
Property Owner Name
Carol Hargadine
Applicant Name
Carol Hargadine
Contractor
Gary Hooley Heating & Air
value of Construction (labor, materials, profit)
$2448.00
Address
City/State
Zip
Phone
612 Morsman
Fort Collins
80526
631-9109
Address
pty/State
Tip
Phone
612Morsman
Fort Collins
80526
631-9109
Address
city/state
Zip
phone
1314 Webster Ave
Fort Collins
80524
493-3272
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? 0 Here O Report
tax numBerisrCqu/rc+dbyallcwrtrdcltNS
34734 . Are you paying with your trust account? d Yes Cl No
3473
Is this a residential or Commercial project? 8 Residential 0 Commercial
If residential, is it. M Single Family Detached ® Condo/townhome (single family attached) , ❑ Dupiex
C3 Multifamily (apartment) 0 Garage
If cor hmercdal, is it E3 Bank CI Bar CI Church Q HoteVMotel 13 Medical office G Office ❑ Retail
13 Restaurant E3 Other (explain)
Is this building so years of age or more? 0 Yes 0 No If yes, yaa lwy need to contact HlsD]ricPrcSCvvat/on
If this Is for a demolition permit, what year was the building constructed?
D`prior to 1975, YOU wl//need an asbestos assessment to submit with this applkadon.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontrautom. list Me campanyname or Gly of Ft Collins license 9
Bechid3k. Pfumhe• T Mechanical H-1654 Roofer - Other
1 nereuY 21dcnow►ed9e 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 constructinn, I know that a
Permit is not valid until It has been paid and issued.
Applicant:Printk Nam eShe ryl Johnson
Signature j a-� tsti
Date
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