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HomeMy WebLinkAbout1724 Springmeadows Ct - Applications/Plumbing - 05/31/2013City of /--Fort Collins Planning, Development & Transportation 281 N. College Ave P,O, Box 580 Fort Collins, Co 80524 / phone 970-416-2740 Fay 224-6135 41 OVER-THE-COUNTER. PERMIT'S CAiLYVv�'. This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning 0 Demolition (interior non-structural) 0 Electrical Alteration (not service thanItewer"Line. 0 Glighter Q Gas Log F[J-leating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing © Photo -voltaic ❑ ventilation . Nater Heater "CI Water Line 0 Wood1PeI1Bt Stove (must be, certified, provide make, model and manufacturer). Job 1 o3ou�+ Complete all applicable information on the application. Incomplete applications will not be accepted. Application # [93021 Balf Date 3 (- 3 For of 'ce use only Job Site Address treaurredl 17a� Spr i5 Prooerty Owner Nam9- adnui.�.f � Address Address Value of Construction (labor, materials, profit) F(- 9053' 35�50d - City/State Tin Phone Zip b.q=-7 -7 -7: J. Phone Contractor Address City/state Tip Phone Al(avt Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? �1, Here XReport Sates tax n um bcr is required by an contracras Are you paying with your trust account? Yes 0 No ,y Is this a residential ci�ryrnmercial pinject? 9d'r_!4enbal ❑ COmmerdal If residentlal, is 1$ Single Family Detached❑ Condo/townhome (single family attached) C3 Duplex ultlfamily (apartment) 0 Garage , If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 13 Medical office • ❑ Office ❑ Retail ❑ Restaurant ❑ Other (exXIL,331n,), ' Is this building SO years of age or more? O YesoIyes; ypu may treeIf this is for a demolition permit, what year was thlding Constructed? If prior to 197S, you will nrAr�an asbestas- asseswienf to submit with 6)4 application, of not ►nst owe VrrnKierlbacktlow preventer, must Iist licensed plumber, If First-time Ajc, must list licensed electrician, Subcontractors: L& the company name or Gty o(F'r Collins license p Eledritian Plumber Mechanical Roofer Other 1 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. F know that a permit is not valid until It has been paid and issued. Applicant: ` Print Name: 6ri� � Signatur pakc }' bT/£T:abed b£T9b226:01 8bbb b8b OL6 aorn.aag ua11lJ:W0ad ££:ST £T02-T£-AIJW