HomeMy WebLinkAbout927 E PROSPECT RD - APPLICATIONS - 10/9/2014s Z_Planning, Development & Transportation
�Ci ylc A_ i \. College N.
Ave P.O. Eox 58G
3 l Fcr Collins, CO E0594
a3, aaa> js m a cI. art a 1 Phone 70- c-_7 J rcx ZZ a'3-
OVER-THE-COUNTER HE -COUNTER PE-2MITS OINL i
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 Loa
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ 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 accepted.
Application # 7p> 1 Z Date /�-`%-/
For ofr7ce use only
Is this a residential or commercial projectZ /n Residential 1-1Commercial
If residential, is it: ❑ 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 11 No Ifyes, you mayneed to contactHistancFreservah'on
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submit with this aXAcatran.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name cr City of Ft Collins license #
Electrician Plumber Mechanical Roofer W Other
I hereby admawledge 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: /
Print Name r a signature Date 1,4
/0257 so g.:rs°9, 11�. 96_ • io% 7719