HomeMy WebLinkAbout4436 STOVER ST - APPLICATIONS - 12/2/2014Dec 08 14 08:30a
p.2
CIty �
ort
This applicatii
0 Dartioltion
❑ Heating Unil
❑ Ventilation
manufacturer).
Complete all i
Application
Planning, Development & Transportation
,o�lln� 281 N. College Ave P.G. Sox•5B0
For: Collins, CO 80524
�\ Phone 970-416-2740 -Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
edor non-structural) 0 Electrical Alteration (rot service chance) ❑ Gas Lighter ❑ Gas Lcg
❑ Lawn Sprink;er ❑ Mobile Home replacement C Roofing ❑ Sewer Lire ❑ Photo -voltaic
LNater Heater ❑ 'Water Line ❑ Wood/Pellet Stove (must oe EPA certified, provide make, model and
Plicable information on the application
1 [[ 105
For ofn7ce use ool:
-
Incomplete applications will not be accepted.
Date f -7, - 2-.
Job site Addr
4�3�
ass (requi,ee)
ST-a✓x_�—
�^ —
value of Construction (labor, materials, profit)
c2'700
Property Ovine
Name
Address
City/State Zip
Phone
�1cu�
at 99l0
applicant Narr.R
Address
CitldState Zip
Phone
�.5_.QLl3270-610-16
Contractor
Address
City/State Zip
Phone
I' Contractor Ci
of Ft. Collis Sa es
Tax
` �a!es rax nr ntxr
,wired b7 atr co,;:a
ram.
7,7
Are you pay:-ig with your trust account?
2f4es ❑ No
iIs this a resider cat or commercial prejert? Residential ❑ Commercial
If re5ldenGal, i5 it: ZZhICIle Family Detached ❑ Condolta.•mhome (Single Family attached) ❑ Duplex
❑ Multifan-ily (apartmient) ❑ Garage
If commercial, I i it: ❑ Bank 1= Bat ❑ Church ❑ Hotel/Motel ❑ Medical etfice ❑ Office ❑ Retaii•
❑ Restaurant ❑ Other (exiolaini _.---------... _
Is this building 50 years of age or more? ❑ Yes �Z_No !(Yes, you may need to conta•�t N.%storlc Preservation
If this is for a d molition permit, what year W35 the building constructeV
I`Pbb, to 147 you will need an a.-tllestes assessment to submit lrnth Chrs applicacron, S �A_ f
Description of work
*If lawn sprinld rlbackflov, preventer, niusi list licensed plumber. if fir;i-6me A/C, must list licensed electrician.
Ust the company narna or City or ct collirs license
Plu, -ter Mechanical Roofer Other
2
I hereby admo- ledge tnat 1 have reed this applicaticn and state that the above information is complete and correct. 1 agree to
comply with all jeciuloaments contained herein and city ordinances and state laws regulating building constructon. I know that a
permit is not 4alid until it has been paid and issued.
Applicant; ) . /
Print Name: c, r" - LJ.�n�'-clj 3iomitu'P6 ate 1 Z —z—