HomeMy WebLinkAbout2124 Ryeland Ln - Applications/Gas - Log, Line, Pipe - 11/03/2011Cityof Planning, Development &Transportation
} 281 N. College Ave P.O. Box 580
FOIf�!� 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 information on the application. Incomplete applications will not be accepted.
Application #2l it boo Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Owner Name
Address
City/State Zip
Phone
_Property
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990-669-69co
Applicant Name
Address
City/State Zip
Phone
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Contractor
Lic # Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax
Are you paying taxes here or by report?
❑ Here E!Z port
sales tax number isrequiredbyall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ET'SS—ingle Family Detached ❑ 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 5o 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
*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 Col/ins license #
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 until it has been paid and issued.
Applicant: Print'Name: J0
a - Signature
Date