HomeMy WebLinkAbout1148 EVENSTAR CT - APPLICATIONS - 7/22/2015av
A CoMn
Planning, ,ile velopni;ent a Transportation
281 IN. College Ave P.G. Box 580
Fo E nilinz, cr, ang24
Phune c70-416-2740 Fax?,24, 6134
OVER-THE-COUNTER PERMITS ONLY
"This application is to be used ao apply for the following permits only (check all that apply), i` Air Conditi.ening
C_l Demolition (interior note-strixtural) U Electrical Alter:?ion (nol zerice chonge), 2:7 Gas Uvhtsr ❑ Gas Log
0 Heating t.nit ❑ Lawn Sprinkler Ci €Aobile home replacement 0 Roofing ! i Sower Line ❑ Photo -voltaic
El1 �nlilation .3 Jdatar Hester f � Water tine 0-, `�J=god/pellet Stove {must be EPA certified, provide; snake, model and
riiankifacturer).
Corimlete all ar3plicable information on the 3=1k3tion, Incompiate applications will not be accepted.
vDate
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Application lic ction "
O1)Ro Use- OJi%Y
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Job Site Address J od Valuefly" �Co nstructior (labor, r, atf ---`\itt)
_
Property rlwrer dame Address
)J City;_SLate Zip Phone. "j'-C
rl -+ j\ .: i'\ ^• �' f µ :'T . j— /•`mot 1 V r ,t - : �C• y-.: ;n _ J•,. .. t �.,.. t . n ..ia
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Applicant Name Address CitylState Zlp r Phone
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Contractor ;' i Address City/state Zip Phone
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Contactor City of Ft. Collins Saies'Tax xr Are you paying taxes here or by report? ❑ Report
a. s:arnanOar&requi,-e?diyeiiAre you paying with your trust" account, .-EY' es E] No
Is this a residential or commercial project? _LTRes:det ia! 0 Comrnerc€ai
;f residentiaE; is it: , •.2"Sine,., Family Detacherl Iw r ondo(iownhon)e (s!ngla family att��chedI C! duplex
El MuMfortAy (apartment) G Garage
:f car•)r,:er::iG', is it: 0 Bank ear Ej Church 0 Hotel/Mote€ ❑ Medical office %;,`• office ❑ Retail
0 Restaurant- CC Gsthei (ex.plain j .......... --- ---------- ---------------------- -
Is this build ir:g 0 years of age or more? ❑ Yes ❑ No ?f ye , you may reed to conect ilrsMris l�resevatior2
It this is for a demolition pernsit, whrit year was the buiiding constructed?
rpHorto 1975, you xvi:/ rug:?d.an ashestjs vssessrrJer;( lam^ svi2mit with t/,&app/ic-ati�,�.
of .J>:ark
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^``I !stun ..sprin`rlei/l)ackel::•sv p:c?�r:.rater, mc:st lis'L,'ee�tsed p:umber. li : irs't-tiros :1; C, ;rsust list tic::n ,aid e1c�-fri:.i�i;t.
Subcontractors: List d?e cowp;317Y .dins or G7tV of FtC)?l,'J?s l.Jrt=hsz Y
E! :. ri:lar. Pi3lnhzr -� �. -_? 'Mechanical
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I hereby acknov:ledge that I have read this application anG state that the above lnforrnation is complete and correct. I agree to
co,nl ly rJitit ail requirements contairted. herein and city ordinances and state lav;s regulad: tg i:tuikiliig construction,. I knave that a
Permit is not. valid until it has been paid acid issued.
Applicant, t
Print Alain: � N. , -i
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