HomeMy WebLinkAbout3500 Carlton Ave - Applications/Gas - Log, Line, Pipe - 11/15/2013NOV-15-2013(FRI) 16:09
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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 -COUNTED PERMITS ONLY
This application Is to bo used to apply for the following permits only (check all that apply). -Cc619dlUoning
Demolition (Interior non-structural) Electrical Alteration (not service change) Gas L(ghte Log
Heating Unit Lawn Sprinkler Mobile Home replacement Rooting Sewer Line P
Ventilation We ter 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 # 'JO L2lvS Date
� oAke usr only
Job Site Address (mqutmdj Value of Construction (labor, matt rlals, profit)C�Yu.. nJ AVE N L -3 2Ce
Property Owner Name Address City/state ZIP Phone
r. AP,*f wtLk4t-T- 3S-W Cnrz.� ,Ave NLt3 co 8CaS2S yy;
Applicant Name Address
City/State ZIP . Phone
contractor Address Clty/State
P Phone
WL;-r� FIee?4%�SuF'P1.�i'' 14p�jtetJr�tlaCO�
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? Here
saicrrwnrmtrertsroukto 4Y a# =Cracl= Are you paying with your trust account? Yes o
Is this a residential or reiai-p„oj Commercial
residcndaf, Is
It: mIl Oetmh` r Condo/townhorne (single family attached) Duplex
Multifamily (apartment) Garage
If Commercial, is it: Bank Bar Church. Hotel/Motu Medical office Office Retail
Restaurant Other (explain)
Is this building 50 years of age or more? Yes o f yr� yqu mayneed to ccnta�k/fib p n,,sAon If this is for a demolition permit, what year was the bu ing Constructed?
.frprlor to 197% YOU wit/ need an ,ssbcsros asse=.anr to submrr Kith ibrs OppliCpb'on.
"Ir lawn sprinkler/backnow preventer, must list licensed plumber. If mrst•tIme A/C, mu,t list Ilcen; ed eleCtrlclan,
Subcontraet:ars: List the compvny ndmr orGrya/R Colvin, licerle A
9euriGan�� plumber Mechenlpl
Roofer��� Other���-
I hereby acknowledge that I have read this application and stare that the above Information Is complete and correct. I agree to
comply with all requirements contained herein and City ordinances and state laws reguladng buiiCing construction. I know that a
Permit is notvalid until It has been paid and Issued.Me
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