HomeMy WebLinkAbout3015 Morab Ct - Applications/Gas - Log, Line, Pipe - 06/24/2013*3�.91
City of
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 # b 130 31 H
For office use only
Job Site Address (required)
-30/5 ,t�VRil6 CT
Property Owner. Name Address
Applicant Name Address
' N i2 r J %L/ l 1� a3�7 CC) • ITN 5
Contractor Address
Contractor City of Ft. Collins Sales Tax #
sales tax number is required by all contractors. ( t L Y `
Date/a I
Value of Construction (labor, materials, profit)
__�)6O elo
City/State Zip Phone
City/State Zip Phone
1 D,GO =237 1/v-643-y993
City/State Zip Phone
r /1)UiV/�,
Are you paying taxes here or by report? )(Here ❑ Report
Are you paying with. your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ,Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office El office ❑Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ 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 s ~
*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 N-I9� / 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: �i'f P-I S le) it I ' Signature Date