HomeMy WebLinkAbout4625 BRENTON DR - APPLICATIONS - 2/13/2018I
Fon Cal [ins
291 N. Cdfege Ave P.O. Bmc 580
Fort: Coll -Ens, CD 80524
Phone 970-41tr2740 Fax 224.6L34
_A}'A ri-
This application is to be used to apply for the followstg permits only (check aIItimt apPly), 0 Air Conditioning
0 Demolition gftiarior non-struchwal) ❑ Electrical Alteration (not service change) ❑ Comas lighter ❑ Gas Log
0 Heating Unit Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line ❑ PhotD-vollalc
❑ Ventilation Water Heater ❑ Water Line 0 WoodlPeltet Stove (must be EPA cer mcf, Provide make, model and
manufacturer -
Complete all apple imp mnadion on the applicabwL Ind applicabons will not be accepted., ,G , CO
Apron f9Q ( l0( .Date
For a use onty
Sob SUB Address (rime* Value of Cwm&ucWm (dw, rrwwdal�, Pry
4 � 2-5 13 re,r 4o n_ Dr. S2'i I I D q
Property Owner lame Address City/State 07 CM 1 zip Phone
Applicant Name Address MY/State ZIP Phone
ryily r� U-L �cGI'vtiEt} hN �t - ��al-W-d-X ISW3 ' � OG%
Contractor Address-- Qty/state ZIP Phone
Contractor City of Ft Collins Sales Tax # Are you Paying taxes here or by report? ❑ Here ❑ Report
qxh� twc,=60 i5 ,eq,'by A mr&aftr5. Are you Paying with your trust aamunt? 0 Yes ❑ NO
Is oils a I P I htial orcojivnercial projecL7 0 Residential 0 Cornmendal
If residential, is it JKSIngle Fw* Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 IMulbTamfly+ (apartment) 0 Garage
If mmrnercla}, is it: ❑ Bank ❑ Bar 0 Church El Hotel/Motel 0 Med tal office ❑ Office ❑ Retail
0 R,egaeant 0 Odw (explain)
Is th-Es bulftg So years of age or mare? O Yes 0 Poo If yes, you may need to aontad Hismrk: Preservation
If thisis for a ton� Y the
If PTIu to 1975, will
assessmentto submit with this appficaft
*If imm sprirwea/backnow prevents, must fist fia sed Plumber. If f mt-time A/C, must fist tip i rfden
Subconuscb= = the confpaily name or City of R Collins hawse #
I tEaeby ackmmiegige that I have read this application and state that the above information is complete and oorrect I agree to
o>mply with all requirementsaontairred herein and aiy ordinances and state laws regulating building oonstruction. I Biro teat a
permitis m*vaHd UdM Iiiras trees paid and issued.
Appilicant
Perm Name: