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HomeMy WebLinkAbout921 E PROSPECT RD - APPLICATIONS - 9/12/2014City of Fart Collins This application is to be used to apply for the f 13 Demolition (interior non-structurap 13 Electrical ❑ Heating Unit © Lawn Sprinkler Cl Mobile Hoff ❑ Ventilation C3 Water Heater 17 Water Line EY manufacturer). Complete all applicable information an the aoa Application 4, For VOW sse w7/y lob Site Addrew (Iagv ad) 9.�1 'C. Pr 2", Property Owrw me�x .address Applicant Name Adds Contractor Address mi�Esrtc, �c� L.i�O 4�. Contractor City of FL Collins Sales Tax # semtaxrurnrliertrre+ UordbYBAaabs*M 9S3`i' Is this a residential or eommerdal project? • 8 A If residential, is it R Single F NIV 11eMched 13 Muttilamuy (apardnerrt) If Commerial, is it: Q Bank E3 Bar 4 Church 13 Restaurant C7'Other(t Is this building 50 Yeam of a" or more? 0 Yes If ties is for a demotition permit, what year was Ifp1rorto 1975, Yav W11nMd%W aM05W5aZ9=7 Description of work Plannitte,'Dwelopment SL TWWsp nUtioe 281 N. C)lege Ave P.Q. &w sso Fort Collins, CI 80524 -Phone 970.416-2740, Fax 22+6134 NTER PERMITS ONLY lowing permits only (check all that apply). 13Air Condhioning Iteration (not service Change) Ca Gas lighter ❑ Gas Log replacement p1 Roofing O Sewer Line ❑ Photo-vohalc Dod/Pellet Stove (must be •EPA certified, provide make, model and Incomplete aP011eatlons will not be accepted. Date �- )a- 19 Value of CAnSInr CUM (labor, materials, profit) City/state zip Phone 11411.r. C1tY/Sole Tip Phone 9tY/State Zip Phone Are you laying taixes here or by report? 11 Here ❑ Report Are you paying ►fI ywr trust account? E Yes ❑ No ential ❑ comrnerdai CondM6c mhorne (single family atl w d) 13 Duplex Garage HD-WMotel 0 Medical office 13 Office ❑ Retail � / _ •, '-/ a ♦r �r.�� .. a r. ... AI. u• •r. �. ' '.' •� `-' 1 i i _�/ 11. i;�.,n If lawn sprirdder/baddiow preventer, must au licensed plumber: If Mst-Urne A/C, must list kieerrsad ded rwn. subc0t'aaC1nrs: c 5t ft a>r, veyr.wW er aey Grq ' . VP&w&ffS& a ee�� Eedridan Plumber—.! Roofer Other I t>i eby admowledge that I have read thts aPP stake that the above irft,,i on Is oompk to and owect I agree to LPN with all requiieurlenfs oortlamed herr8n and cfiy and stale laws regulating buidinp ooristruQiorr. i loeow that a Permit is not valid until it has bean paid and i'A9Na�1� _�r Appli=ft 1 It ) 1 Print Name:_U Pe� _ MAV 'Sig Inc w _ 9"/`]� i