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HomeMy WebLinkAbout625 MANSFIELD DR - APPLICATIONS - 4/13/201504-13-'15 09:42 FROM -Premier Roofing Flirt othns 9704848308 T-316 P0003/0004 F-612 Planning, Development & transportation 281 N. College Ave P.O. Box 580 Fort Collins, C080524 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). Cl Air Conditioning 0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter C7 Gas Log Cl Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Rooting 0 $ewer Line ❑ Photo -voltaic C7 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 #��� • Date For office use only Job Site Address (required) Value of construction (labor, mis, profit) (A a5U(3 � Property Owner Name Address City/state Zip Phone N \)-e.-lier Applicant Name Address City/State Zip Phone araM1110 Contractor Address City/State Zip PhoneQ40 evr Contractor City of Ft. Colli ales Tax # Ar ou paying taxes here or by report? *Here 0 Report Salrs�xnumberlsr¢pulredbya/lcrontradorx Are you paying with your trust account? ❑ Yes 0 No Is this a residential or c9mmercial project? 'C&Rssidential ❑ Commercial If residential, is it: JASIngle Family Detached 0 Condo/townhome (single family attached) 0 Duplex 13 Multifamily (apartment) ❑ Garage If commercial, is it: 0 Bank 0 Bar ❑ Church 13 Hotel/Motel 0 Medical office 0 Office ❑ Retail (S 0 Restaurant 0 Other (explain) Is this building 50 years of age or more? t] Yes o If yes, you may need to coniactHlston'cRm&valfon If this is for a demolition permit, what year was tife building constructed? Ifptfor to 1975, you will need an asbastos ass&ment to submit with this appilc 60n. of *If lawn . nkler/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the companyname or City of FtCOI&SAMse # Elech7dan, _- Plumber. Mechanical — — Roofer 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 requirements contained herein and city ordinances and state laws regulating building construction. It know that a permit is not valid until It has been paid and Issued. Applicant: Print Name fn Q_ Signature Date