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HomeMy WebLinkAbout436 BAYLOR ST - APPLICATIONS - 7/12/2019Fo Collons Manning, ©eveiopment, & iransportaition Services Community Development & [Neighborhood Services 281 North College Avenue For-, Collins, CO 80524 Main: 970A162740 Fax 970.224.6134 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 ❑ Lavin Sprinkler ❑ Mobile Home replacement Roofing ❑ Sewer Line (3 Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet St manufacturer). ave (must be EPA certified, provide make, model and Complete all applicable information on the application. Incomplete applications >vitl not be accepted. Application # � I I� 4y I)�- Date ror oSce use only Job Site Address (required) Value of Construction (labor, materials, profit) 143b -6,lac 5�. �;Y4 Collins Ca $o5a5 q;L riz.A. Property Owner Name Address City/State Zip Phone ��t i 2� u3e t3« ►,, ,� C,1I1is , Co g05a5 Applicant Name Address City/State Zip Phone Contractor Address �v Cib//State Zip Phone �S'i`fl{)/+•..( o�`.-X'i'h�- Ct?O--or`f�`&rS'6� Contractor City of/Ft. Collins Sales ax Are you paying taxes here or by report? la Here ❑ Report Sales tax nwnberis,erredbya#mno-adom Are you paying with your trust account? E3 Yes ❑ No Is this a residential or commercial project? 74esidential ❑ Commercial If residential, is it: XSingle 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? ❑ Yes ❑ No If yes, you maynee9 to contact HisroncPresenation If this is for a demolition permit, what year was the building constructed? Description of work Aliu9 Ctr�1 NN" or 2 C6s5 rho 1 CCSS� C tt Nl r! 1- 2a vtS ikl i FSia %eQ If lawn sprinkler/baddlow preventer, must To licensed lumber. Zf first-time A/C, must list licensed electrician. Subcontractors:List themmPanyname orGtyofFtCoffins license EI`ctridan Plumber Nechercral Roofer - Other 1 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 vatid until it has been paid and issued. ' ��� ��� Applicant � ' printNama: 1i , .q Signature ti Data _ wri✓,li9 ?_nrrn a:;e 26rza: i