HomeMy WebLinkAbout2200 Yorkshire St - Applications/Gas - Log, Line, Pipe - 05/13/2014Planning, Development & Transportation.
Cityof I � 281 N. College Ave P.O. Box 580
Forrrr` 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
mariufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 1 3 S�
For office use only
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State
Zip
Phone
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Applicant Name
Address
City/State
Zip
Phone
Contractor
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Address
City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co mercial project? 29 Residential ❑ Commercial
If residential, is it: • PSingle 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 50 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 idza&yT1-y kg,r- 414 Lt�, Ri5-1 Ova- 6-1 73 5L �-ra 70 1
DdA)- TAQ— C-rv.c. wHiLN 144t/1AZC— 4 64Y 1rrc. 74 $� ?"r f,� • FL. SHE —
*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 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 a state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
-Applicant: ` ��,�
Print Name: DAA,\ `� l�w� Signature Date
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