HomeMy WebLinkAbout3513 Riva Ridge Dr - Applications/Plumbing - 04/27/2013City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Flirt 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 Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # 51301911
For off1ce use only
Incomplete applications will not be accepted.
Date Li - OL W
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
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Contractor Lic #
Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Mere
❑ Report
Sales tax number is required by all contractors:
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? lE Residential ❑ Commercial
If residentiali is it: '9 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
❑ Restaurant ❑ Other (ex lain)
Is this building SO years of age or more? O Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you wit/ need an asbestos assessment to submit with this application.
Description of work GM, Li i J(? ('pegs u4e 7�eST f-6� 0 T\ L N i `r s fw2T 'JP
*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: >1 SignaturC�z� Date LG `r�
Print Name: �X�' �D