HomeMy WebLinkAbout1317 Teakwood Dr - Applications/Gas - Log, Line, Pipe - 01/23/2013JRN-22-2013(TUE) 10:33
P. 001 /001
Fort CoRins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416•2740 Fait 224.6134
OVER-THE-COUNTER PERMITS ONLY
nis applicatior Iv tO be used to apply for Gie foliowing permits only (check all that apply). Air Conditioning
Demolltion (interior non-structuraq Electrical Alteration (not service change) Gas Lighter Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -voltaic
Ventilation Water Heater Water Line WoodlPellet Stove (must be EPA certined, provide make, model and
manufacturer).
GomplCt4 all applicable Information on tho application. Incomplete applications will not be accopted.
Application #�Jo 0;1 ` (date
For office use only
Sob Site Address (required)
V317-- &v,t."JoaA
Property Owner Name
Applicant Name
Value of Construction (labor, materials, profit)
S Da,
City/State Zip Phone
F (— CO 51) S-7 .< 7-7 1 ,,, e
City/State 7Jp
. C.10 e& SZS
Contractor
Address City/state zip
P. �ifr IOC° l my-b `lye 1k 49P 1:6 C✓o eoSZ
Contractor City of Ft Collins Sales # �
Are you paying taxes here or by report?
szt.r&xnumwIsrequfreday'?#warr crm Are YOU paying with your trustatcount?
Address
iin YeGkwood
Address
f---tV PYCi& %Afr
Phone
c6- 9 6-7
Phone
Here ep
Yes
Is this a residential or commercfal project? sldentla Commercial
If residential, Is it, Single Family Detached do/townhome (singie 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 Ifyes, You mayncrd 1p tgrttast j/;yYpno F1enafion
If this Is for a demolition permtk, what year was the building constructed?
Ifprior to I90,, �you wit! need an asbestos asszsmenr to submit with this app/iCab'on.
Description of work l �dl "Z Z Ci 1 -3o
v = w QV r�hr , ✓
"If lawn Sprinkler/backflow preventer, must list licensed plumber first-time A/C, must Ilst licensed electrician.
subcontractors: I.isrdietompanynameorCity nfl}Collinslkcnse if
ElecvidenN Colt
.�Mechankal Roofer � Other
I hereby acknowledge that I have read this applicatlon and state that the above Informatlon Is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state law, regulating building constructlon. I know that a
permit is notvalld until It has been pold and Issued.
Applicant: �Tee J
Print Name.N n
Signatue iSetc 1-Z.Z.'13