HomeMy WebLinkAbout412 ROBIN CT - APPLICATIONS - 8/30/2017Planning, Develo
: a 281 N. College Ave
V�)•y �jL�y Fort Collins, C080!
- ' . T Phone 970-416-271
OVER-THE-COUNTER PERMITS
f l.:s application is to be used'to apply forthe following permits only (check all tl
r j,,molibon (interior non-struc(ural) ❑ Electrical Alteration (not service change) ❑
I Heating lJnitJ ❑ Lawn Spriniier ❑ Mobile Home replacement ❑ Roofing ❑ Sew
r h Ventilation t�Water Heater Q Water Line ❑ Wood/Pellet Stove (must be EPA ce
nldnufacturer) /
t;onholete all applicable information on the application. Incomplete applications
Date
Application
� �' 17n � 4>_5' �y
` rv�
'ou Site Address
p, opei ty Owner Nz
r.
use Orrr�
ad/
N n
�+
Address
� " 1 Address
CK)ntiactor city bf Ft. Collins
. /;: u( uunrberis rz4ulrcdGyall
Is dus a ,esidentlal or mmen
II he5nlenllal, is it• ngle
jit commercial, is it• ❑ Ra u 13
;rai
'h:, building 50 years of age
I dA; is for a demolition Perini
fl v to 1975, you will need an
1)escnptlon of work
h If Town spnnaer/oawlom v+=•=�
suot:011Uactors, Last tha cnnlpal
1 ♦lV1 JI0mt� puM
:o",•hv ackuowledile that I have
„mply with all requirements rant
'._cnmht is not valid until it has
vent & fransportntloi,
P.0 Box 580
valve of constmo
city/State
/State
4N, t, 6
city/State
ff� fa • to d
Are you paying taxes here or
Are you paying with your b LL
rojed2 iderf4al ❑ Commercial
lly Datach d O Condo/townhome (single family atl
(apartment) ❑ Garage
gar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑
❑ Other (explain) tow"
rnore7 0 Yes ❑ No Ifye� YOU
what year was the bulld)ng constructed?
_........,� �•.,.a,„nnnr io submit wldl this apP//mBon
.,,._'_
must Ilst licensed lumber. If first-time A(C, must Ilst
Ime orc7tyofFtColllnslicense #
Medwnical__.. Roofer
Fax 224-61: s
ON Vf
at apply) ❑ Air Condltloniny
as Lighter ❑ Gas Log µ
r Line ❑ Photo -voltaic
,ified, provide make nwdal I- to
this application and state that the above information Is
herein and dty ordlnances and state laws regulating bl
i paid and issued.
not be accepted
(labor, materials, profit) 0 O
7jp Phone
�i).�_742-798s _ ,
Zip Phone_
Zip Phone
y report? ❑ Here RhReport
account? 'lSttyes ❑ No
hed) ❑ Duplex I
:lice ❑ Retail
,
.Y His[orlc Pre51'Nabnn
electrician.
outer
eta and correct. 1 agree m
construction. II(r.owthat,.
a I /L %
, ` 36 /
ortnrNar::eL_Itn1 ."'m `C� signature u�.y-k" �."- l _ vate
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