HomeMy WebLinkAbout501 Sand Dollar Ct - Applications/Gas - Log, Line, Pipe - 11/11/2011NOV-11-2011(FRI) 10:28 P.001/001
City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Flirt Collins Fort Collins, CO 80524
Phone 970-416.2790 Fax 224-6131
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only.(check all that apply). A Itioning
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter Gas Lo
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -voltaic
Ventilation Water Heater Water Line Woad/pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete aoclications will of be acceoted.
Application
For office use any 1
lob Site Address (required) Value of Construction^(labor, materials, profit)
tr'1C lw<7< 110
Owner Name Address City/State Zip Phone
- —
Applicant Name Address aty/State ZIP
Phone
Address r, City/State ZIP Phone
Contractor City of Ft. Collins Sales Tax x )
Srks rarnumberIsrMu/redbya/l contrarerorx
Are you paying taxes here or by report? Here Report
Are you paying with your trust account? Yes No
Is this a resldentlal or commercial Resldentlal Commercial
If residential, Is It: le Family Detac Condo/townhome (single family attached) Duplex
Multifamily apartment) Garage
If commercial, Is It: Bank Bar Church Hatel/Motel Medical office Office Retail
Restaurant Other (explain)
Le this building 50 years of age or more? Yes No lfyas you may need to Contact Nisroric preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestes as,: sment to submit with this application.
ption of
*If Lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, mu;t list licensed electrician.
Subcontractors: List the cornparry name or Gty of Ft Collins license ?
neetriclan Plumber. mechnnlcal Roufcr. Other.
I hereby acknowledge that I have read thls appllcarlon 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. T know that a
permit is not valid until It has been paid and issued.
Applicant: J���� �� 11 Print Name: �l Signature