HomeMy WebLinkAbout4436 STOVER ST - APPLICATIONS - 2/17/2015From
02/17/2015 09:24 0128 P.002/002
of Planning, Development & Transportation
�F6 t Collins Fort N. College Ave P.O. Box 580
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 Conditionin
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) El Gas Lighter ❑ Gas Log g
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-volialc
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application #` _ Fj 1 S61(Q
SxoAi'rn use on/y
[;3obite Address (rcquhed),ve �ty Owner Name Address
C. C{-.t..ti_1rvS
Applicant Name Address
Contractor
Date L - i -I - 1
Value of Construction (labor, materials, profft)
J
City/State Zip Phone
�(—'C7_?f _.tc.' T•
City/State Zip Phone
n 5 i -7C �3
City/State Zip Phone
'-c) vv LcVE��Ni> co 4Lc37
Contractor City of Ft. Collins Sales Tax #
Sales tar nunzleris rr9urrmdbya#cwrt+aa�vx
=f lC`i 1
tct\,t f i4
Address
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Are you paying taxes here or by report? ❑ Here l3 Report
Are you paying with your trust account? ATYes ❑ No
Is this a residential or commercial project? )21 mercial
If residential, is It: ❑ Single Family Detached Residential ❑ Condo/townhome (single family attached) ❑ Duplex
) 13 Garage
If �kMulticommercial, is it: ❑ Banks i] Barr O ChumilY trch ❑ HOW/Motel, ❑ Medical office [3 Oftiice ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years Of age or more? ❑ Yes ONO If yes, you nmyreaytocnrrtactHl5toric P mermtion
If this is for a demolition permit, what year was the building constructed?
IfPV.r to 1975,, AV rv/llneedan asbestos asmssment to subm/t w/th this aplxlicatyon.
Desaiption of work - -e • - .e (ac.e�v ea:cj
*If lawn sprinkler/backfkrw, preventer, must list licensed plumber. first time A/C, must list licensed elecician.
SubeOfrastprs: Ust the company name or atyWIT Co#ins /rIf cerrIf a
se
Electrician (lumber M P- 3 2-4l
— _ _____� Mechanical�_ Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and corned I agree to
comply with all requirements contained herein and city ordinances and state laws Permit Is not valid until It has been paid and issued. regulating building construction. I know [trot a
AppikanL-
Print Name: JAN] E G,
Signalvre�� � �_ �i1 ,�- Date