HomeMy WebLinkAbout4130 SUNSTONE DR - APPLICATIONS - 6/11/2012Jun 08 12 02:21 p A J Shirk Roofing 19706695999 p.1
p�Pase final L 10er��4- 7Z) ou r ice
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C� , L)V�e j ctv2a Cv Planning, Development & Transportation
,�"� fl0 53 7 281 N. College Ave, P.O. Box 580
F®rt ` oldie Fort Collins, CO 80524
� Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER
This application is to be used to apply for the following perm
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet St
manufacturer).
Complete all applicable information on the application. Incoi
Application # � 0 �`I 9
For office use only
Job Site Address (n paired)
Property Owner Name Address
Applicant Name / Address
-A--s shirk ori'�oFI�G
Contractor dress
7r.
Contractor City of Ft Collins Sales Tax # , (/ O 3 Are you
Sales tar numbar&raga edbya#cw#adws� Are you
Is this a residential or commercial project? tklll�siderrtial ❑ G
If residential, is it: )S44imgle Family Detached ❑ Cando/townh
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes,
If this is for a demolition permit; what year was the budding con,
Ifpnor to 1975, ynu wl/I need an asbestos assessment to submit wl
ONLY
rly (check all that apply). ❑ Air Conditioning
e change) ❑ Gas Lighter ❑ Gas Log
Roofing ❑ Sewer Line ❑ Photo -voltaic
[must be EPA certified, provide make, model and
applications will not be accepted.
of Construction (labor, materials, profit)
Zip
/=C
Phone
231-�
Zip
Phone
Zip _ Phone
u n u L o O rJ-7 -� r V /O'-f -CO 7 7
taxes here or by report? ❑ Here .9 Report
with your trust account? X Yes' ❑ No
(single family attached) ❑ Duplex
Medical office ❑ Office ❑ Retail
may need to contact Historic Prieservadm?
Description of work Tc er rr aAf4- 4o c4 e c k .
-L h s-G I/ C9 , C. /J k ra -/- 1 0 r-r
f S
4 n r 17 r ✓h-, yr r/ .,; C^ k
*If lawn sprinkler/backilow preventer, must.list licensed plumber. If first
time A/C, must list licensed electrician.
5ubconbacLors: List the mmpany name or airy ofFrC fts Hearse if
P, 1580
Electrician Plumbs Mechanical
Roofer l` Other
I
I
I hereby acknowledge that I have read this application and state that the
�bwe information is complete and correct. I agree to
ith comply wall requirements contained herein and city ordinances and
laws regulating building construction_ I know that a
permit Is not valid until it has been paid and issued. -
/1
Appficant; L / �/
Print .,! Name:14 4 h, 7`� VUh64� Ssgnature %
�t
Date
I
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