Loading...
HomeMy WebLinkAbout630 MARIGOLD LN - APPLICATIONS - 6/4/2015Plannina_ nPVPrnnnfon* n. ram......_ ' 281 N. College Ave P.O. Box 580 r rnCJ FortCot„ 4 Phone 97o-41627Fort 40Fax 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-struchrral) ❑ Electrical Alteration (not se ce change) ❑Gas Lighter ❑Gas Lcig ❑ Heating Unit El Lawn Sprinkler ❑Mobile Home replacement Roofing '❑ Sewer Line ❑ Photo-voltasc j 13 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/pellet Stove (must be EPA certified, provide make, rriodel manufacturer),. and Complete all applicable Information on the application. Incomplete appllcations will not'be accepted. Application # Date_ For office LWonly —r— ' i Sob (�� Value of Consbvction (labor, materials, p ) ` �� I t YA CO t Property Owner Name Address Gty/State Zip ph ' l �� s Cn r7la( N Applicant Name Address City/stateZIP Phorte Contactor Address Cfir/State � C-1-154 -7777 w.`�- Q�� Contractor City of Ft. Collins Tax # q M5' j Are you paying taxes here or by report? ❑ Rat J�alesAre you paying with your trust aocount? ❑ Yes No I project? Residential ❑ Commercial Is this a residential orR959millmy(apartment) I I If residential; is it ily Detached ❑ Condo/townhome (single family attached) ❑ Duplex i ❑ Garage If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 59 years of age or more? ❑ Yes ❑ No, ifyes, you mayneed to con/actHcstorkpreservabbn If this is for a demolition permit, what year was the building constructed? s i ifpdorto 1975, you MY need an asbastos assessment to submit with thisapp/icafion. I i I � a Q i 7Descrniptionwork bacidiow preventer, must list licensed plumber. If first-tirrle A( must rest rro rsed electrician. L&ffie mmpanyname or GlyoffrCo//iM&OW se # ©ectriaan Plumber MechanicalL. Roofer Other T j I I hereby admowledge that I have read this application and state that the above information is complete and correct i ag I comply with all requirements contained herein and City ordinances and slate laws regulating building construction. I latow I to brat a Permit is not valid until it has been paid and issued I Print WameCYJ-C1&gmre�9OZ4� q Date I