HomeMy WebLinkAbout415 Smith St - Applications/Plumbing - 09/14/201209/14/2012 10:23 FAX 0 001
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J City of Planning, Development & Transportation
w y �+ y� �' 281 N. College Ave P.O. Box 580
Vrl}Collins
IJ �✓1 Fort Collins, CO 80524
Phone 970-41&2740 Fax 224-61M
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning °
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service changeGas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing firSawer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodfPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # a )`0
r'a�Wonly
Date 9 ` /0' i a 01,
6)-
]ob Site Address (required)
Value 44 Construction (labor, materials, profit)
��5 ��i>✓ �- •
9 Oct. � v
Property ner Name Address
city/state Mp
Phone(?7 o
cCGu ekovcd s
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Name Address Criy/State Tip
Roo i ier1r IC_i1: ?il '14q 5.l+Ffr1Cly I'A34q7 Ft:Ot,111'r);,CD.FSC��,�y
Phone
Contractor Llc: i ' M P- ' N Address
Nn, ctivefl h lcr ac o
'hf .1r� 7yq. `a.L�'nigt
City/State Zip
�Ai �42 Ft. oll,ns �'a.
Phone
f-r8-7x
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? X Here E7 Report
Saks tax number & required by all amftctom
Are you paying with your trust account?
10 Yes )KNo
Is this a residential or com0tercial project? WResidential 0 Commercial
If residential, Is It: WSIngle Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is It: ❑ Bank ID Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant E3 Other (explain
Is this building 50 years of age or more? D Yes 04qo If yes, you may tined to contact Htslodc Ptesenotlon
If this is for a demolition permit, what year was the building constructed?
If ptfor to 1975, ynu will need an asbestos assewnent to submit WM ibls appllcatlon.
Description of work
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust tde company name or City of R Collins 11manse ,C
9ectddar Plumber Medianial Roofer Other
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 corsouctlat. I know that a
permR is not valid until it has been paid and Issued.
Applicant: nn / "I
Print Name: RLYt --Signature l� gate
10