HomeMy WebLinkAbout921 HAZEL CT - APPLICATIONS - 11/19/201411/19/2014 21:12 FAX.
0 001
of
Flirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort 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 Conditioning
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater i7 Water Line O 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 # ?::>I 12Do Date 11/19/14
for al ce use only
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: 0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
t7 Multifamily (apartment) M rar.,oA
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Q Medical office ❑•Office ❑ Retail
❑ Restaurant Q other (explain)
Is this building 5o years of age or more? u res M No 11'yes, yuu pray rrml [v rvnta�rt /ustvr>e IYcxnatron
If this Is for a demolition permit, what year was the building constructed?
D°prlor to .1975, you W11 need an asbeskas aszga�ment to submit with this appl/catrOn-
Descrlptlon of work liemove 1 layer of modium Cedar chokes Instep proper fimhings ice n water shield on eaves and
in II Instalt Dora gone Copled- steel class 4 roofing material
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/Cr must list licensed electrician.
9ubaAntrectorO: U.rt the cnnpon), name M C;i , of R r-nllinc dronca 0
decMcian� Plumber Mechanical Roofer X Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct, I agree to
comply with all rcquirementc contained herein nnri pity nMinanrps and state laws mulatina building construction. I know that a
permit Is not valid until It has been paid and Issued.
Applicant: 11119/14
Print Name: Craia Schultz Slgnature—L-JJ-AP- Date