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HomeMy WebLinkAbout437 DERRY DR - APPLICATIONS - 8/29/2017Pb 28.1 N. %Uege Ave P.O. Box W wnig-1%. FortCollins, CD80524 - -- r` Phone 970-416-2740 Fax 224-6134 �5? < 4! �L__-i 1 i i < _'7,yARE M M 103 1 r• This application is to be used to apply for the yollowirrg peffnks only (check all that apply). lJ Air Condih'onmg ❑ Demolition (Interior non-shucirual ❑ Electrical Alteration (not service change) ❑ Gas Lighter p Gas log © Healing UfFP Lawn Sprinlder ❑ Mobile Home replacement o Rooft o server Line ❑ Phob-volia€c Q Ventilation Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA cmfded, provide make, model and manufactamr . ConpletB all -appAcable infonmation on the applicstion_ €ncornpletee aPplicaficons w-ft not be accepted. Application # f--)06 2Q2 Date F. For afiiae use a* Jab Sft /.ice Cjrequ� Value of Consbetoa (labor. mab3ials, pr'ff) v-.. Drive 13 Prop5W Owner MM ZIP Dr. Ca l�hs Phone s�9 �Address f CAD 5 Applicant NamQ r. rvi 4� r Iri Address City/Slate ZIP 5co I U V t 't-}5h i -c:.. Cf C70 40i-A -N -ISG 43 Phone -7� 19?X . Addres>= City/State Zip Phone Contractor City of Ft Collins Sales Tax }' Are you paying taxes here or by report? Q Here ❑ Report sal- tax mister is repamed by au mwacwm Are you paying with your trust account? ❑ Yes ❑ No IS tttts a res#dertt�l ar profert? ❑ Residential O Commercial ff residential, is fi MSmgte Family Detached ❑ Condojtownhome (single family attached) ❑ Duplex ❑ Muff family (apartment) ❑ Garage ff commardt, is it— ❑ Bank ❑ Bar ❑ Church 0 Hob*motel Q Medical ofFrce ❑ Office ❑ Retalf 12 Restiamant 0 omer (explain) Is this building W years of age or more? oyes ❑ No I-r yes, you may need to contact Histoft Pree►raiion If this is for a demshTiitlon pauft what year was the building constructed? If prior to 1975, you malt creed an asbestos assessment to submit with this application. *If fasp inWer/brh�e addlow preve, must list Hansed plumber If fist -time wn A/Cr must list [IMMsed doh. SUbcontractiNsc List the compaiay name or Gty of Ft Coffins racise # f a Ptuaaaher fit RWw Ogg I hereby adawwfedBe that I have read this application and state that the above infamallon is oxnpiete and cavrett I agree to comply wh all reclutrementsar IF; red herein and city ordiinartces and state taus reg<rlaBrtg buitdirhg caristruci3on f [scow that a Pamft Is riotvalid MM it has been paid and rued. t�trnr etarrre {;L4 �t i tJ (11 <) Simtature lit V