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HomeMy WebLinkAbout433 CLOVER LN - APPLICATIONS - 11/3/2015cfty of F® Collins 281 N. Cagege Ave P:O. Box 580 [ Fort Collins, OD 80524 Phone 97o-416-2rr4o Fac 2246134 OVER-THE-COUNTER PERMS ONLY Thts appfleation info be nsW to apPfy for the fiolloWq PeMUS Only► (Check all tlratapplyI. O Air CxmcWonmq ❑ Demolition (interior non-&udural) DEW- I Atterafion (not service dmMe) O Gas L'ghW 1313as Log 0 Heating Unit ❑ lawn Sprinkler 0 MobVe Home replacement 13 Roofing O Sewer Line ❑ Phot"Oilaic ❑ Ventilation O Water Heater O Water Line O WoodWeMSI)m (must bQ EPA certified, Pwdde rrmlcI model and manufachm). Complete all apAucable information on the application. lncomPlete apPliraflorrs w111 not bs accepted. Application *. 31567O55 Data //- 3 - / 5- lob Sita Adrlr+�s (re.P# 0 Value of Car�struc on (labor, materials. Profit) q 33 Cl�rer L& Ii e- ?CM Properly owner Name Address QW/S'tate Zip Phone Sc,ra,k f(-azier 1( 3 3 er- Jij Pj_ C 00 a I - r Applicant Name Address CLYI-Slatle Zip Phone Contractor Address My/Stde zip Phone fb 6D g - 13 Contra CflY of Ft: Coffins SMeSTax # Are you paying tMW trine or by reports t Cese 0 Report salestaxnwnberts aq�orddt�l'a!/r�ar!» Aye 1m PaTM wah Wm' -13 Yes M4 6 is this a reddentiral or commovW Prune l 13 C Merdal if ressidential, is ft M�figie Fenn'fl+ Detafhd ®Cormdo/isn nhome (ftle fandly attachaQ O Duplex 13 Muitiifamly (apartrnent) 13 Gage r commercial, is it: 13 mnk O Bar 13 GUM:h ®ItatelWOW 13 Nlerlid office 13 o ice O Retail o Restaurant ©€ the'(wPlain) Is this buMng 5D years of age or mwe? O Yes ONO Tryetr yaumayrreed ro m Kv i"cP °n If this is for a demon pemf w►hatYearwras the b'Mdirag cnmuclop Ifprlortof975, your+v�7lneeds!]a�tD9l6P1itWFtlitlusappb�ho/a l — S -t-o r Description of work a *If lawn s drMer/baddlow prMEW, must fialwng d Piranbe: - fIWA4 me A fC, mmtfsstliaerrsed dedsidan. Subcontracts=LwMv MMMWASMdraYaFFMr6W aaw# D-74 BMW dan PWMber _ omEr I hereby edma wledge fhatI have rind tlrisappt and stfttitthe alx orma1 'Is osnrpEete and czam : I agree 10 comply wall requirements omia-med heydn and dtv w and statE buHdmg oa>strutan. rfih Y lma.+that a permit is not wAd =W itlms Ireerr paid and bsue'L Appurant; Print I@w=, ray ��