HomeMy WebLinkAbout4142 MOSS CREEK DR - APPLICATIONS - 6/9/2015vvivelav+.o Avn ";4w ran 71voo34oao rravanvev noosing
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City of
Planning, Development &Transportation
ztll N. College Ave P,O, Box s80
Fart Collins., CO 80524
Phone W0-4Yb-2740 Fax 224-5134
OVER-THE-COUNTER PER1111TS ONLY
This application is to be used to apply for the: following permits only (check all that apply). I7 Air Conditioning
❑ Demolition (interior non-s7ructural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Loa
Ln Heating Unit ❑ Lawn Sprinkler u Mobile Home replacement ❑ Roofing ❑ Server Line G Fhoto,vcltaic
❑ Ventilation L7 Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be -'PA certified, provide make; model and
manufacturer),
Complete all applicable in rmation orthe picaticn. Incomplete applications will net be accepted,
-61
Apolicarorl Dare 6e
For oh5ce use only
7e+o Sits Address (reguiredl
Prcperiy Owner Name ,Address
r�-L\J c3nt3GCD f 1`13 C= Add, as_-
7 g k�vt
��Conti—actor LIc x Address
Contractor City of R. Collins Sales Tax
Se%S tar number /�; rrwir&d by aA mnb'acinn.
r�'DlO 5ld
y=1;1a of CorStruCti: r (labor, materials, pront)
�) 7_ act
Citylstate
City/StLt2
Coll ZIP UT -a_ 6 Phone 4� '7o
ZIP
City/State Zlp
Are you paying taxes her- or by repo(`? ❑ Hera ❑ Repori
Are you Paying with your trust account? ❑ y-s ❑ No .
Is this a residential or commercial project? XRpsldendal 0 Commercial
If, residential, Is it; KSingle•Family Det�rchad • 0 Condo/tcwnhomE (slhgle falliily a ge ed) ❑ Duplex
❑ Nlultifamily (apartment) 0 Garage
If Commercial, Is -it: ❑Sank ❑ Bar CI Church Ci Hetel/h(otel ❑ Me�ic2l cries ❑ Oi1Ce ❑. Retail
M Rcsturant ❑ Other (explain),
Is this building 50 years cf.ayN or rncro? ❑ `(2s ❑ No If yes, ycer mayneecrro craCac: HIstarir. ?,enervation
If this Is for a demolitio,; permit, what, y-_r yrrs the building constructed?
Ifprlor to 1975, you will na Q' an as4 :.Log es_armen+t h SuSnit avitr-2 th/r app#C317cn. -
Description of wcr'<,_i'1
*Ii fawn sp. inkler/bacicilaw pr _ tlnt�r, rnl,.,: Ilst lira;a;ad .nfumber. If firs:-urrl:: A rni!sc
Subcentrec arts: lino tf•<c:,mp:.v;ynair.�� or ?F;• r"i`', Call%nsr(:e17Se
Hectrrcan _ PILirbe'
..__..___—.� f•I �','S;niC?� _ KCn(nr (v ,1.j�G.1 �J�/�it_. Gtncr
I hereby aclCnoWledre :h : l hdvE icEd r,,;l:$ %:OgIC?%: U, %r:d SuC= that the soave inFomla:iacal;, n is- pieta and corac , I ecr-ce to
comply with all requirements CAninim--d hereln end ;it/ ordinances Fnd 5 3te Id4Y5 re;L•lri;nq build-ino c.Uns-- uction. I know that a
perriit is not valid until it has bean paid and issued.
Applicant: ( {�
/,,,�f / Lam'
Date