HomeMy WebLinkAbout6826 Nimitz Dr - Applications/Gas - Log, Line, Pipe - 07/09/2013City f Planning, Development & Transportation
FY o281 N. College Ave P.O. Box 580
lirt 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 infor ation n he application.
Application # ���
For office use only
Incomplete applications will not be accepted.
Date Jul� _ 2013
Job Site Address (required) Value of Construction (labor, materials, profit)
ive *) (000.
Property Owner Name
�usseS LLC I
RC \)eo
Address City/State Zip
) ReSlwfAk l one I Ee C
Phone
I303)WAU
Applicant Name
1-r CCoke
Address City/State Zip
t" t. Lmrlaxdco
Phone
3
Contractor Lic -Ja1
Y
Address City/State Zip
D^
r Phone
6
Contractor City of Ft. Collins Sales Tax #
sales tax number is required by all contractors
Are you paying taxes here or by report? X Here ❑ Report
Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached j(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 gNo if yes, you may ne-4 to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? ff
If pnor to 1975, you w/11 need an asbestos assessment to submit with th/s appl/cation.
Description of work
*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 k J y
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: II,,^-yawPrint Name: F'�Pcl C[�Lc Signature Date