HomeMy WebLinkAbout4112 MOUNT VERNON CT - APPLICATIONS - 4/6/2015/' ;. 7.
S Ptannin9r Development & Frans
281 N. Colle9e Ave p.0. gox 580 P4rta7an
`~ FoTT Collins, Co 80s24
ah,one 97,0-415.2740 Fax 224-C;34
®VER-THE-C��1N7�
This apPlicaiion is to be u R PERMj�� Demolition (interior ,;�n- used to aPP1Y for the foilowin ONLY
u hfeating Unit 0 • s uctur,;i ❑ i;lectrjoa: A$teratiorpertnits only (ehecic all that a
Ventilation .aw" SprinKter b ,Ltobile Nance repiacemeont s� Ice c. PPiY). it Air Corcritior frig Wa,er Heater � � ; thansei ❑Gas Lighter � Gad Log
manufacturer) V✓ate. Line ,_ ;n/ocd/Peii2t Steve RoO.ing sewer
Complete all a dine op. oto-voltaic
pplicable information on the tr ust be Spq certifad, pr^ ;
wv.ee make. Model and
application, Incomplete a
Application 150 a�-7� Upplications Will not be acceoted
For oJ3r"c• use only Date V-4,1y---
Job Site Address
a Value Of Construction ;iabcr, materials, prof ; ?rope,OrOPertil OWner dame 1 r"4
Address C:h;/gtate
APAIiCant Nance / Phone
Addrass
Zip
0..
' Contra � _ a" "o
—, Address '
iP
�-antractor City of Ft Collins Sales Tax
SalK!axnumCer;sre areJ l Are YOU paying . r
ty al ono-aC prS 1 p Y G :axes here or b
Are you paying wish w Y � eport? 13 Here ti Reoort
Your truss accour t? C Yes l�No
.s this a residentiat - ComrnerCi@I pro'ec ?
if residential, s it 1 Rside?Ciai r-Omr,�erQa: � — �-
i Si,.gle =amily Detached 0 Condo,/ h e
❑ Multifamily (aoarU cent) ! Garapetown, •cm ;s: gle fami!Y attar"eC; q D o!;X
iif Commercial, is it: n sank
w Bar C Church "1 .e,
Restaurant p C. No ,jY� p' ve�ic2i p Ce C.,;Ce ❑ . I
?5 this building 50 ygdts of age ar „tare?er (explain; rr �2taii
this is fora demOlitiOn permit what LIJ'es :Vo ;ryes, you,nayreeatc MiZaC,Histo�c16, cation. 1iPri0r lb 1975, you iy%ll necy' an asbestos dssessmenCas 01� �o'sGb e ` t, thisaFPli�aticrt,
Description of work k�
xIf +awn ,sprinkierrbackflo:v preventer, must tist licensee o:umbcr. I' f rs, -,.me A!,, Jr list
Subcontractors: List the Ccrrpany name Or City Of F:• Corl•'ns 4,&-n5-S
Eie?r,'C,en_ Cl�mpa: +�ecrrnG/ "�l+�l
I herehy acknowledge that _ have read this application and state ;hat the above information Is COmolete anc Correa. I agree to
comply with all requirements contained herein and c ;y ordinances an: Sate laws rcu:sting building ccns ruCi;on. i know that a
permit is not valid until it has been paid and issvcd.
Applicant!
Print Name :a
• .— Date