HomeMy WebLinkAbout3012 W Prospect Rd - Applications/Plumbing - 10/02/201310/02/2013 16:20 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-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
El Demolition (Interior non-structural) ❑ Electrical Alteration (not service changes) � Gas Lighter ❑ Gas Log
❑ Heating Unit C3 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing USewer 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 #
8(30519Q
For ofte Lisa only
Date -
Sob Site Address &Wulrnd)
Value of Construction (labor, materials, profit)
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Property )woer Name
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Addf�s
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City/State Zip Phone 9�0
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Applicant Name
Par) I (i�r1rleli. eii j44
Address City/State Zip Phone
a _Lfrrl�y. A3••ly2- FT. 06116),; 40, FfiSZq TV—qqN-3513
Contractor i c,' M P - .7 lc{
Aid r'ther'rl CAD 1pra4te
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Address
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city/State Zip Phone
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'9 Fi:�--iqz F t. I line C'D.��-
ContracWr City of R. Collins Sales Tax
#
Are you paying taxes here or by report? Here ❑ Report
O �
Sales tar number Is re gwned by all co tractom
Are you paying with your trust account? Yes XNo
Is this a residential or compwcial project? ta-Prsldentlal ❑ Commercial
If residential, is It: G-ISingle Family Detached ❑ Condo/townhome (single family attached)
C3 Multifamily (apartment) C3 Garage
If commercial, Is It: 13 Hank ❑ ear C3 Church 0 Hotel/Motel ❑ Medical office 0 office
❑ Restaurant ❑ Other (explain)
Is this building 50 years of aga or more? ❑ Yes ❑ No Ifyes, you may need to contact Hlslrarrc Prrservaflon
If this Is for a demolition permit, what year was the building constructed?
If prW to .075, yr a will need an asbestos azwsment to submit with this appllcawn
Description of work
13 Duplex
❑ Retail
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed elecMdan.
Subcontractors: List the =mpany name or Oty of R Collin lic mm 0
Elea ian Plumber Medwical Roofer Other
I hereby acknowledge that I have read this application and state that the above information Is oDmplebe and oxTect. 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: Reyt Hel 1 f IC- I L5EI j Signature -�``^� paw