HomeMy WebLinkAbout5120 Stetson Creek Ct - Applications/Gas - Log, Line, Pipe - 04/10/2013IJ�1`LI> 11tie) fN-s
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City Of Planning, Development & Transportation
I 281 N. College Ave P.O. Box 580
� „,_ 6r L+ Collins Fort Collins, CO 80524 .
Z �� 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
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -voltaic
Ventilation
manufacturer). Water Heater Water Line Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #_. 6 1 ?jb I(0:� Date I D - I
For ofce use only
(required)
Value ooffConstructions(labor, materials, profit)
ElobSitedress
5or.1 c �E��3ner
Name Address
City/State Zip
Phone
AUG4L_1rN SIZ5-3 STI 1Sorl GQ6 r.L 5DS25
-775-3S7b
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
wG-,71-2r3 F= 2EOIskL_e SoPpLI ft>8 P , -J &L S or_ F-L_ 8o5Zy
1-198 —9G-7`
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here
tax number is required by all contractors.Are
you paying with your trust account?
e�esales
Yes
Is this a residential or commercial project? Residential ercial
If residential, is it: Single Family Detached Condo/townhome ngle 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 fyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the bull ding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work 2_1=PLLt=
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician 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:
Print Name: `-1 � � ��IX/ .,./V` 2 —
Signature Date � —� O—'tJ-