HomeMy WebLinkAbout719 Stover St - Applications/Plumbing - 06/18/2013Cit of Planning, Development & Transportation
y} 281 N. College Ave P.O. Box 580
j,!Or` 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. Incomplete applications will not be accepted.
Application # 1 2, () 2q Date I3% 13.
For o>?lce use a only
lob Site Address (required) Value of Construction (labor, materials, profit)
')l 1 S?oue-2 s 1$ goo ,06
Property Owner Name Address
City/State Zip
Phone
/. �S/ Tol
C Gv �Jc
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
Sa r, c:
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
sales tax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? �A Residential ❑ Commercial
If residential, is it: K 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 (explain)
Is this building 50 years of age or more? ❑ Yes t%No 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 will need an asbestos assessment to submit with this application.
Description of work' 2� o�/►�� 1.uA-7&P- L1ti1t:f Jr 1"g7-Ae-L. 076rri2 A-
*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 #
ElecMdan 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: Signature
Date