HomeMy WebLinkAbout612 Griffin Pl - Applications/Gas - Log, Line, Pipe - 01/09/20131/9/2013 9:29 AM FROM: Fax Lind's Plumbing -Heating, Inc. TO: +1 (970) 224-6134 PAGE: 003 OF 003
planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
For
t Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 /
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 ❑ Roofing ❑ Sewer U c 0Dh
❑ 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 # 13 CJO I C1 a Date r' 4 " -I
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State tp Phone
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Applicant Name
Address
City/State Zip Phone
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Contractor `
Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here [)I(Report
Sales tax number isrequiedbyall contractarn
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Are you paying with your trust account? X Yes ❑ No
Is this a residential or commercial project? alkesidential ❑ Commercial
If residential; is it: 13 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
17 Restaurant ❑ Other (expl fn)
Is this building 50 years of age or more? ❑ Yes E3 No Ifyes, you mayneed to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed? .
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinider/baddllow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City o(R Collins license 9
Hedridan Plumber Mechanical 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 construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: r
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Print Name: t . _ Signature f "i +7 �, Date 7