HomeMy WebLinkAbout4130 SUNSTONE DR - APPLICATIONS - 5/23/2012Rues, LLC
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r 970-619-8074
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Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # �) �� 3 �0� Date 123� 12�
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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$ 2 0 92
Property Owner Name Address
City/State Zip
Phone
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17Y. :Furl2
Applicant Name Address
Clty/State Zip
Phone
Contractor Address
City/State Zip
Phone
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A11Q(4a8DMA4Wf
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
Report
saleslay number isrequrredbyall contmcrors.
Are you paying with your trust account? JMYes
❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: [Ri Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprfor to 1975, you ml/ need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkder/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 4
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: S—ACL&r L„�i J
Print Name. l.Y 1 �i7
Date 2311
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