HomeMy WebLinkAbout932 THORNHILL PL - APPLICATIONS - 1/14/2019City of _
Planning,, vPy Deveeloepment & Transportation
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This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑Electrical Alteration (notegAce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing ❑ Sewer Line ❑ 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 #�1aJ\qc%)�,343 Date
For office use only
Job Site Address (required)
°13 —rho P
Value of Construction (labor, materials, profit)
2 h o r �'c 11
'T's 1 5 . a 0
Property Ow ne Name Address
en k1icK- T32.76rnW)
City/State Zip
21 FIColltns
Phone
65�
n
gp
92
Applicant Name Add ess
�►- a,,
City/State Zip
4
Phone
cSc /1/lan csrc
i.d oar —b(#F
7205b 1996
Contractor Address City/State Zip
ES R alordb 21o374) o inf r-#F allyrS
Phone
20'%11
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?(Here ❑ Report
.Sale, tax number is required by all contactors
—13B '�3y a
Are you paying with your trust account?
es ❑ No
Is this a residential or mmerdai project?Residential El Commercial
If residential, is tt: J� Single Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
Cj Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to J975, you will need an asbestos assessment to submit with this application.
of work
C /it6z
A:Le
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: lJst the company name or G'ty of Ft Collins license #
Electrician Plumber Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above information is complete and'cbrrect 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.
Print Name: ! V l b a Q.I t SGL 2t ,A signature M d n d,��Date 114 /%
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