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HomeMy WebLinkAbout654 CARRIAGE PKWY - APPLICATIONS - 10/20/2015Resendli-05-i5;09:33AM•; ;970-484-4448 # 9/ 9 Planning, Development &Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply forthe following permits only (check all that apply). ❑ Air Conditioning XDemolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log Hanting Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line Cl Photo-voltalc /❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # �150 " -1 Date for office use only Job Site Ad (required) Vxiue of Construction (labor, materials, profit) au 1411+u co S�oS� y 10� Pl erty owner Name Address City/State Zip Phone SOL 11Cry�eI • I� Applicant Name SArrr-i f a --' -n w Address City/State Zip S. Lil1;,' s.�. Inc. �� YD5A ' Phone q70-1134-119V Contractor Address City/State Zip Phone IV Poe, e Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here +Report SalrstrrrrumbcrlsraquirrdGysl/contraCMr�, rota � n Are you paying with your trust account? 17.Yes ❑ No Is this a residential or commercial project? sldential ❑ Commercial if residential, Is It: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex '❑ Multifamily (apartment) ❑ Garage If commercial, is it: O Bank ❑ Bar CI Church ❑ Hotel/Motel Ci Medical office ❑ Office ❑ Retail © Restaurant © other (explain) Is this building So years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contect/•OstorkPreservat/on If this is for a demolition permit, what year was the building constructed? Leprior to 1975, you W11 fieed an asbestos assessment to submpflth thls appllcat/on. Description "`If lawn sprinkler/backfiow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician. Subcontractors: Ustth;pcompanynemeor0tyof'FtCa111nslicense# L•IaelNclan, Plumber. Mechanical Roofer Other I hereby acknowledge that I have read this application and state that the above Information is complete and correct. I agree to comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a permit is not valid until it has been paid and issued. Applicant: n Print Name. RI 111fM Signature ..