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HomeMy WebLinkAbout4436 WARBLER DR - APPLICATIONS - 6/24/2015Resend07-02-15;08;070 ; ;970-484-4448 # 4/ 19 %.quy • 8 ADJ. N. wuCyr rwe r.v. oux oou Fart CoUins 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 (cheek all that apply). ❑ Air Conditioning ❑ Demolition (Interior non-structural) Ci Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log ❑ Heating U It ❑ Lawn Sprinkler CI Mobile Home replacement CI Roofing 13 Sewer Line © Photo -voltaic 0 Ventilation Water Heater C1 Water Line ❑ WoedlPellet Stove (must be EPA certified, provide make, model and manufacturer) Complete all appl icable Information on the application. Incomplete applications will not be accoptod. Application # Date nA__ 4160 For o/l/ce use only Job Site Address required) Value of Construction (labor, materials, profit) 114 3 A le 8 t Ea Tie • F6 d 0 So51 &- Property Owner Address city/state zip3b5"+ Phone a x. o aA dab-y5&P- Applicant Nam Address City/State Zip Phone Contractor Address Clty/State Zip Phone n r'C c. /o i i . PL & g0,�y ��'y y/ Contractor City of Ft. Collins Sales Tax •# Are you paying taxes here or by report? ❑ Here �fiteport Sales�rnumtrer�D�lDedbye/Imno-acm1z Are you paying with your trust account? Yes 0 No Is this a residential or commercial pmjecl? identlal ❑ Commercial IF residential, is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex , Muttlfamily (apartment) 13 Garage If commercial, is it: ❑ Bank Cl Bar E3 Church C3 Hotel/Motel © Medical office ❑ Office Q Retail D Restaurant 13 other (explain) Is this building so years of age or more? m Yes CINo Dyes, youmayneed to confactH/sior1vFreservat1on If this is for a demolition permit, what year was the building constructed? ` Ifpr/or to 1975, you W11 need an asbestos assessment to submlt w/tfi thisapp/1®don. Descl•iption of work *IF lawn sprinkler/backnow preventer, must list licensed plumber. If first time A/C, must list licensed electrician. Subcontractors: Ustdjecompanynameore7tyofRCillIlw/lculLw ' Elecbidan Plumber Mechanleai Roofer other. I hereby acknowledge that I have read this application and state that the above Infounatlon Is complete and correct I agree to comply with all requirements contained herein and city ordinances and state laws regulating building construction, I brow that a permit Is not valid until It has been paid and issued. Applicant: Print NameSLxr; a jDate l -egL —lJ'