HomeMy WebLinkAbout2843 Zendt Dr - Applications/Gas - Log, Line, Pipe - 12/06/2011DEC-06-2011(TUE) 10;41 P.001/001
City Of Planning, Development & Transportation
Fort Collins 281 N. College Ave P.O. Box sao
Fort Collins, CO 80524
Phone 970-116-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (chock all that apply). Alt, ditioning
Demolltion (Interior non-structural) Electrical Alteration (not service change) Gas Lighter Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -,a_ a c
Ventilation Water Heater Water Line WoodlPeltet Stove (must be EPA certified, provide make. model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # \ L 1 10 S ( Date__�a t
For of a use only
Job Site Address (requiX
Value of Constru 'on labor, matt I IIs, prog
r_)\ I KI L2
rerty Owner Name Address Cityisinte Zip Phone
11
Applicant Name Address City/State ZIP Phone
Contractor _1 Address City/state Zip
1\__ N___ -.� Phone
Contractor City of FL Colllns Sales Tax # r1-1
SSkS err number 4s r�uirrd by ill eantraetars
Are you paying taxes here or by report? Here Report
Are you paying with your trust account? Yes No
Is this a residential or et, Lpcoaec� esldentW? Commercial
1f residential, Is It a Faml etach�ed, 6 ab townhome (single family attached) Duplex
Multifamlly (apartment) Garage p
If commercial, Is It: Bank Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explain)
Is this building SO years of age or more? Yes No Ifyrs, you may need to conmerH/sro ye Rm er a6an
If this Is for a demolition permit, what year was the building constructed?
If prior ro r97$ yvu wi// need an asbestos asses:menr to submit w/rh tills 7pplicadon.
n of
"if lawn sprinkler/backflow preventer, must list licensed plumber. If Arst-time A/C, must, list licensed electrician.
Subcontractors: 4& me c►7mpanyname or00, of Ft Collins/lCcnse Jr
Clertrielan - ,_ plumber Medianlol Roofer Other
I hereby acknowledge that I have read this application and state that the above information Is complete and correct. I agree to
damply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
parmit is not valid until it has been paid and issued.
Applicant:
Print Nam:-3_QS\Slpnatur:_ Date