HomeMy WebLinkAbout1618 Collindale Dr - Applications/Gas - Log, Line, Pipe - 12/20/2013 (2)0EC-20-2013(FRI) 14:25
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City of planning, Development & Transportation
F6rl Collins 281 N. College Ave P.O. Box 580
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 (chock all that apply).
Demolition (interior non-strucluraq Electrical Alteration (not service change) Gas Light Gas Lo-
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line o o-voltaic
Ventilation Water Heater Water Line Wood/Pellat Slave (must be EPA cerlilied, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accoptod.
Application 4 Date 2.0
Forol/Icr use Daly
lob Site address (requfrrd) value of Construction (labor, materials, profit)
WT Cb L 4--4 N QLiLS S71(t.tvS 4� LE f j --
Property Owner Name Address CIWState Zip Phone
7MEQ5LLC- -rD&r- i6L E LAW CowlW—D&S Do- Fc e-o &M,5 %0 .�15
Applicant Name Address
Ciky/State Zip Phone
Contractor Address CItyl54te ZIP Phone
iN rxtJ PlE SuppL.-• 1406 IQIJq IDt: -� J'Go $tt�ly 9ifd
Contractor aty, of Ft Collins Sales Tax #
alesraxnLMbCrerr&gUkVdbyA#aurrra Are you paying coxes here or by report? Here �
1' I Are you paying with your trust account? yes
Is this a residential or co pro a esldential Commercial
If residentfat, is it: Single Famll D ownhome (single family attached) Duplex
m y (apartment) Garage
If commercial, is It: Bank Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explaln)_
Is this building So years of age or more? yes Np y Wumayneeo to mrrGget hYstoriCrvaUon
if this Is for a demolition permit, what year was the building constructed?
!lprrar ra l975, yr�u will aced an a756eAt $ as!%=errt to submlt with this appl/dtion.
of work a
"If lawn sprinkler/backnow preventer, must list licensed plumber, If nrt•dme A/C, must list licensed eiatrleian.
Su boon tractors: w pre comAVny a sme or pry of Fr Coll ns Gcerrse s
kleoridnn--� plumber
[�tedWmlcal rtoofer Other
I hereby acknowledge that t have read this applicatlon and sate that the above Information Is complete and correct t agree to
cemply with all requirements contained herein and City ordinances and state laws regulating building construction. Y know that a
Permit is notvalid until it has been paid and issued.
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