HomeMy WebLinkAbout6126 CARMICHAEL ST - APPLICATIONS - 6/27/2019 (2)lsianningr Davelopmentr a, Transportation Services
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OVER-THE-COUNTER PERMITS ONLY
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 (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement P Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ 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 # S 1 q I �Lf Date
Forofflee use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip i Phone
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Contractor City of Ft 611ins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sa(estax number lsrequiredayall conbacwrs. Are you paying with your trust account? Dr?es ❑ No
is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: ,KSingie Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
❑ 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? ❑ YesgNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Descriptio of wo 1 M M r- S'l Vl 3 S G
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*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Lave company name or GLyofFt Collins license #
Eledricien plumber Mechanical Roofer oh Y_\�ther
I hereby acknowledge that I have read this application and state that the above information is complete and correct 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. -yr— p r/ n /n�
Applicant: i� a. i 1 ` (,&M � 1 /In � AQ� ( f/ V lip �^�Y Date S
Print Name: V 1 I "Signature
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