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HomeMy WebLinkAbout930 WHALERS WAY - APPLICATIONS - 9/11/2014CEP-8-2014 14:28 FRDM:CEDRR CREST ROOFING 970 669 6152 T0:2246134 P.1/1 of Planning, Development & Transportation City F6.} ! 281 N. College Ave P.O. fox 580 1 t Collins Fort Collins, CO 80524 Phone 970-416-2740 , Fax 22+6134 OVER-THE-COUNTER PERMITS ONLY This application Is to bb used to apply for the following permits only (check all that apply). ❑ Air Conditioning © Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter a Gas Log * Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing 0 Sewer Line ❑ Photo -voltaic ❑ Ventilation 0 Water Heater Q Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). complete all applicable Information an the application. Incomplete applications will not be adapted. Application # DLO 7 665 Date Foroh9ce use �' Job Site Address l ned1 Value of Constx > cUon (labor, materials, profit) 93a Property Owner Name Address City/State Zip Phone .; 9UoU.M 9&W!o 4411 A -- Applicant Name Address City/State Zip Phone Contractor LIC # Address City/State f Tip Phone C:50.6 C.2"'e �.%.7 y !r /. < Ar I.• �� i !e r1 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ® Here ❑ Report -%tstar namberisrepudadbyall c aftclws Are you paying with your trust account? ® Yes ❑ No Is this a residential or commercial protect? © Residential © Commercial. If residential, Is It: ® Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex • 0 Multifamily (apartment) 13 Garage If commercial, Is It: 0 Bank 0 Bar ❑ Church 0 Hotel/Motel ❑ Medical office 0 Office ❑ Retail O Restaurant ❑ other (explain) Is this building SO years of age or more? ayes* ENO Ifya$ you mayneed tD wnW HL%Wk Pimivabvn If this is for a demolition permit, what year was the building constructed? Ifpnbrto 1975, you W11 rued an a0es&s asnegsffAwt to submit wo this applIcabivA Description of work TdR a j2,V s ailyr~ V lawn sPdrdder/bacMcyw preventer, must list licensed plumber. If fIrst-time A/C, must list licensed ekftidan. Subcontractors: L& t bye comFwhyname or cityofpeWas lkwrse # GARZo Elechidan Rumber. _ Medranitai _ Roofer R a0 /.JC fie. I hereby actahowledge 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 letued. Applicant: PMnt Name: Q A 0144 Signature .0 J �ie Date 9'A r/