HomeMy WebLinkAbout6001 AUBURN DR - APPLICATIONS - 7/11/2012City of Planning, Development & Transportation
281 N. College Ave . P.O. Box 580
Fort Golf i h S Fort Collins, CO BOS24
Phone 470-416-2740 Fax 224-6134
OVER -THE -COULTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
El Demolition (interior non-structurg U Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line ❑ Photo -voltaic
Q Ventilation Nater Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certifi��ro� �� �, model and
manufacturer) -
Complete all applicable information onthe application. Incomplete applications will not be accepted.
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Application # ►✓ 1 aO`'�('�LL4" Date `� ��"� �- as •�
. For office user ony
Sob Site Address frenuired)
Pri�erty Owner Wimp 1 J Address
AAAA1 p / RDht t1Tl�U
Value of Construction (labor, materials, profit)
city/State Zio - Phone -,-'
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Applicant Name Address City/State Zlp Phone
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Contractor Addre%%sss� City/State Tip IPhone , /
r 4iAX ' a n(iihS �'o5$_/r Tgq' g`7�I
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? l7 were j1;(Report
.sales tax number is requlrad by all cuntractws. Are you paying with your trust account? )4 Yes O No
Is this a residential q r merdal project? Residential ❑ Commercial
If residential, Is it: Engle Family Deta ed ❑Condo/townhome (single family attached) ❑Duplex
0 Multifamily (apartment) ❑ Garage '
If commercial, Is it: [I Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office • ❑ Offlce ❑ Retail
0 Restaurant O Other (ex lain)
Is this building So years of age or more? O Yes ' If yes, you mayneed to contacYHlstor/cPrexervatiar
If this Is for a demolition permit,. what year was th'e__bb ilding constructed?
11 prior to 1975, you will need an asbestos assessment to submit with this application.
Description of
*If lawn sprinkler/backfiow prevent;, must list licensed plumber. If firstdime A/C, must list licensed electrician.
Subcontractors: L1st.thr. compenyname orCityoFRCollins hcense0
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: ,-964r f
Print Name:
5ignatur Date �� �/ �� „•
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