HomeMy WebLinkAbout3143 Sharps St - Applications/Plumbing - 08/08/201308/07/2013 10:13 FAX
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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-TIE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only. (check all that apply), LJ Air Conditioning
_-❑ Demolition (interior non-structural) ❑, Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
1:1 Heating -Unit ❑ Lawn Sprinkler ❑-Mobile Home emplacement ❑ Roofing ❑",Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ZWgeer Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable info►mation on the application. Incomplete applications will not be accepted.
Application # B 13 0 141 c7d
For ofte use only
Job -Site Add re a (required)
roperty ner Name
Applicant Name
nbn 11enrIcll!;el'1
Date
Value of Construction (labor, materials, profit)
Address ty/State Zip-. -- - Phone C/7 0-
Address
INQ S .L+FIYKC
Contractor L I C.- u' M P - `3 Tri Address
Nevtjwew Cblorado
�iral7�iair� 4 �ILl:it� TujCj- ta• LiP!!K
Contractor City of Ft. Collins Sales Tax #
Sales tax nwnber Is mquhed by all emtradws
City/State Zip Phone
''A3• 1 q2 Fr: OtIlfris i Co. S>~>zy 9-lt-yy3...3c1_%_
City/State Zip Phone
A3 1y2 F1, & I Iln3 Co gE, F;2
Are you paying taxes here or by report? X Here ❑ Report
Are you paying with your trust account? ❑ Yes )KNo
Is this a residential or commercial projed7 identtal ❑ Commercial
If residential, Is It: l i1oSrngle Famlly Detached IJ Condo/townhome (single family attached) ❑ Duplex
i] Multifamily (apartment) C) Garage
If commercial, is It: ❑ Bank E3 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No if Ares, you mayneed to contact Hlstnr/c pmservatYon
If this Is for a demolition permit, what year was the building constructed?
1f,ar/or to 1975, you will need an asbestos asgsment to submit with this app//catlon,
Description of work Ludt
*If lawn sprinkler/bacWlow prtventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
ician.
Su hoontraCtors: L& dw company name or aty of Fe Collins license 0
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 untH It has been paid and issued,
Applicant: �
Print Name: F:cvt 1' 'r 1 riCl LStE r I SIgnature �f'� paw