HomeMy WebLinkAbout1327 TOWN CENTER DR - APPLICATIONS - 10/25/2019I
Planning,, t)evelopme all Transportation;
Ct ' OF 281 N. College Ave P.0 Box 580
Cl, Fort Collins;'CQ 80524
Phone 970-416-2746 Fix•224-6134�
OVER=THE-COU�
This applicatidos to be used -to apply for the folloy
❑ Air donditioning 0 Electrical Alteration ❑ Gas Lig
❑°Mobile,Home replacement ❑ Sewer Line ❑ Vent�I
(must be EPA certified, provide make, model and mans
i
Complete -all applicable information on the applicall
GI
Application # I '
For ofte use only
ER PERMITS ONLY
permits only (check all that apply).
❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
i gWaterHeater ❑ Water Line ❑ Wood/Pellet Stove
Incomplete applications will not be accepted.
Date Inla�l I
Sob Site Address (required)
Value of Construction (labor, materials, profit)
13 a'1 Tom r\ Ce,nde.r Jr
av"to . 0'I
Property Owner Name Address
Crty/State Zip
Phone
Todd wotAer� 13a '% n C,,
0,--orb Cntltnn, Co 6o5lq (_270)2-78-t773)
Applicant Name Address
City/State Tip
Phone
Tin04' -rnC(ni Y, i �O
LM lA 190
Contractor Address
yiu- t)'
City/State Zip
ripLO Mai Cl
Phone
0.74`81'n
Contractor Gty of FL Collins Sales Tax #
SzW a number istWain d by all conractom
Uol,aq�] rn 2-
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? )4 Yes
❑ Report
❑ No
Is this a residential or commercial project? ❑ Residenhal ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Gaiage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Holtel/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?
Description of work SnS,J& Qe 5n njQ cn aG c W i Na ` 0 rtel0.0-e,
L>Llsh na Wf16or VIP/i f
*If lawn sprig klerlbacidiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City offt Collins license
Electndan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and cored 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: ?T �
Print Name 'Trn Signature -Date
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