HomeMy WebLinkAbout617 LOCUST ST - APPLICATIONS - 3/21/2018Planalner DeveloOF3ment g.Trarmporim ion
�z 281 N College Ave P.O. Box580
Port Collins, CO 8os24
Phone 970 416-2740 Fax 224-613-A.
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This application is to be used to e 1 for the following permits only
PP Y (check all that apply). D Air Condhianing
13 Demolition (interior non-shucwrap Q Electrical Alteration (not service change) ❑Gas iagh'ter ❑ Gas Log
Q Heating Unit Q Lawn Sprinkler ❑ Mobile Home replacement 11 Roofing ❑ Sewer Line . Q Photo -voltaic
❑ Ventilation `t water Heater Q Water Line Q Wood/Peliet Stove (must be EPA celtiTled, ProlIlde m21c&, mode
manufacturer).' manufacturer). -
Compleie 21I 2Ap12o3b1e informa;3on on the application l icomalete applications mrllI not be accepted
Appl!CcMon Data 2 2 1 a ,a
Foromce use only
Job
SIB >ddr�e (emu/�� 'Value of Cons-iructon (labor, materials, prom
1
Property Owner b �495
ames Address city/Stab: i- Phone
�nn,� Mo►�S�r� -� / -p 9"10 22'10
Apolicanc ti 1sm Address
i 1 : L _ 9 , , , _ r u�?'/S iz zip Phone
--- r u u-j
on��cor U Address Gty/State Zip Phone
d�ir All AltIn,In n.1
Contractor City of Ft Collins sags i ax r f ri. p- / Are You paying taxes here or by reporL7 Q Here IXRej
Safes bx number-isWired bya/1 mnGdttot3 r
l Am you BaYin9 N4th Your MMaccount? (yes Q No
IS this a residenpai or mmerdal project? ❑ Residential Q Commercial
IF residenriai, is ii-- Single family Ceteched ❑ Condottzwnhome (single Family attached) Duplex
P
N commerdal, is iu ���0 Sant: Q �Q hutch Q HH el/ivlotel Q Medical o;noa_ Q ofcy Q REhgi
Q Restaurant Q Other (explain)
is this building So years of age or more? ayes ONO Zi'yzs, you mayneed to r0njaLtM5.t0ffCpWWva&W
it this is for a demolition perms, what year pas the building constructed?
sr prior to rs7S, IMOU .will need an asaesins a sesswni io submfe wj i this appllpfton
description of work
� Ir lawn 5131nkler/baddlow. preMter, III= lirL fl enSed plllMer. F fIi•S[ Uiite Ali colts!; lisp lfeerlced eleefYidan..
Subcontractors!LSt dha C=panynama orQ,orFrCo111n5vicense
Eladaido ---. pjUmh8r
Mecho<uc31 itaofer odw
r hereby acknowtledge that1 have,ead this application and state that the above Information is cwV complY with all requirements contained herein and acy ordinances -and State laws regulating bulidtng cconsaucgon. I know that a
Permit: is nvt valid UIMI ithas been paid as+d issued.
Applicant:
Print Nair,, - __ Signattitri:
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