HomeMy WebLinkAbout1148 CANVASBACK DR - APPLICATIONS - 8/6/20190 08/06/2019 12:51 PM 13034664326 a 19702246134 pg 1 of 2
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Planning, Deadapnrent It Transportation
281 N. College Ave P.O. Box 580
Fort ColAes, CO 80524
Phone 970-416-2740 Fax 2246134
OVER-THE-COUNTER PERMITS ONL
Thls application is to be wed to apply for the following permits only (check all that a").. Conditioning
❑ Demolition (Inroarior non-structurao O Electrical Aftwatian (not service change) D Gas UgMbr Gas Log
❑ Heating Unit O Lawn Sprinkler ❑ Mobile Horne replacement ❑ Roofing ❑ Sewer Line D Photo-volta[c
❑ Ventilation O Water Heater O Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete W applicable information on the application. Incompieti aWicadons(wwiill not be accepted.
Appiifitipn * L I v' OAO�? ? Date Y /rj - f
Foral eLwmy
lab Site (
Value of 13�profit)
�rrr>E `'e4ddress
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Applicant Nacre Address
oty/State 71p Phone
R.ath:L ?@ Khmey
Broomfield CO
Canbactor Address
CiLY/State Tip Phone
cooDer gratUg md Coolj=11780 Colman Way 80020 720-361-4245
Contactor City of FIL Collins Sales Tax #
Are you paying taxes here or by report?X H ❑ Report
SaW rarnurrber [s,egvfred ayaff olfivad=
Are you paying with your trust axxount? es 17 No
Is this a residential or commercial project? U lkesiifentlal O Commercial
If residential, is It" O Single family Detached ❑ Co ndo/townhome (single family attached) O Dupiex
O Multifamily (apartment) O Garage
If eonurreodal, is it: O Bank O aw 0 Church O HotellMotel ❑ Medical office 9 Offrce O Retail
O Restaurant [3 Other (explain)
Is this bulgy 50 years of ape or more? O Yes D No If yas. you mayAsed to cer&d HEslwfc Phew wffo r
If this is for a denwildon Penn*, what year was the buiiciing cons4vded?
Ifpnfor to 1975, wv ari!/ need an asbieR is ass9ow t to aAmft wlttr UrLs app/kabhm
Description of work
*If lawn /baddlow preventer, must Est kensped plumber. If first-time A/C, must Het licensed decWdan.
Subcordracbms I& Meox ony n&m orOyofFtCaFm/A2YAe�
Sectridan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state tat the above Information is complete and correct. I agree to
comply with all requirernerts coat ned herein and city ordinances and state laws regulating building mrutrudion. I brow that a
Wmk k rrot valid wtl8 It has bon paid erred laaued.