HomeMy WebLinkAbout4213 KINGSBURY DR - APPLICATIONS - 9/30/2014This application is to be used to apply for the following permits only (check all that apply), ❑ AirCunciltloning
❑ Demolition (interior non-struciuraq ❑ Bectical Alteration {notservice change) ❑ Gas Lighter ❑ Gas Log
Cs Heating Unit IQ Lawn Sprinkler ❑ Mobile Horne replacement } Roofing Q Sewer Lino ❑ photo voltelc
u Venulstion n LAraier Heater El 1,Var__•r Line rJ Waadpalist Save (mu etba EPA cer9acr, prrnride mom, madat and
manufacturer).
Complete oil applicable information on the application. incomplete applicatiara will not be accaptetl_
Application i�: -P5 14111e,� . Date
ForG7-ke use only
Job Site address pegvircd) aValue of Construction (labor, materials, prof.)
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Property Owner Name Address City/5mte Vo Phone
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Applicant Warne Address CityjSttte ZIP Phone 4-a-
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Contrctor .'address ity/state zip Phone
Contractor City of Fc. Collins Sales Tax �• Are you paying taxes here or by reporre el are. 17 RepwL•
fj sate: t�uum5�tr,equrrdbyrrlmnrraa Are you paying with your trust account? Nryes ❑No
is iJ ua residentlal orcommerciai pmjedu ffRe_srdantlal Eta CommGal
If residential, is it 11 Single Famlly Detached CI Condo/tnwtthome (single amlly atiachad) ❑ Duplex
CI Multifamily (apartment) ❑ Ghmge
I: mmmerda4 is fr: CI Bank ❑ Bar ❑ Churdi ❑ Fatoi/Motal 17 Medical office ❑ on, ❑ Retail
G Restaurani, G Other Cexpiain)
Is this building d0 years of age or morel Ayes G No 3r'ys, you mayneeGv ronbctHsfnrfcPres ruafion
rthis Is €or a demolition psrmi, what year vies the building const•=icwd*-
ir`Rrfarm _975, you rdlJ reader asBesms ,-----mseiasubmfrv�hY1 Jh15 application.
Descript[onofwork In
' T lawn sginkierlbackiow prevetrter, roust ratficansed pWmher. Rfr3 me A/C, musY 115t licensed electid3n.
5ubc0ntrrorr L&rthe campanynvnc or6.pofFtCalGns/lrense �
Re=,reran alutnh� ttacnan7toi RC Tmr Other
I hereby admowiedge dtatI have read this auplicatton and state that the above inkrinallon is romplete and correct I agree to
comply whit all requitemaalscontained hereln and o1y amiitan[a; and 7a'm laws regulating building conshuclion. Yknowthat a
pornih is not valid unfit r', has been paid and Issued.
Applicant: ,1 r-�'._ �• y c
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