HomeMy WebLinkAbout209 Gary Dr - Applications/Plumbing - 10/31/201110-31-11;18:26 ; 2246134 # 1/ 1
lU/6UUJ/CAA IU.1:) MVI voveiupuielm Review CRd lvo. �/U%L4-01J4 f. UU1/UUI
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City, of Planning, Development & Transportation
281 N. College Ave P,O, Box 580
FFdrt Cotfi1 r� i5 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
13 Demolition (interior non-structural), 0 Electribal Alteration (not service change) CI Gas Lighter ❑ Gas Log
C3 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacementJQ Roofing 0 Sewer Line 0 Photo -voltaic
❑ Ventilation C3 Water Heater j�Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model riihd
manufacturer).
Compiet® all applicable information on the application. Incomplete application will not be socepted.
Application # 11092 9 b Date
far afty use only
Is this a residential or c9mmercial project? kResidenifal Q Commercial
If residential, is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
E3 Multifamily (apartment) ' 0 Garage
V commercial, Is k: Cl Bank ,E3 Bar 13 Church I] Hotel/Motel ❑ Medical office C] Office 0 Reb11
0 Restaurant Cl Other (explain)
Is this building So years of age or more? D Yes ANo If yns, you may need lit torttnct H/s1vnc Preservation
If this Is for a demolition permit;, what year was the, building constructed?
lfpriar is 1975 yqu tW//need ari as6estas a-, ea wnt to submit WA!b this appllcadon.
Description of work g Enk o g nv\aA;.- -
V lawn sprinkler/bacidiow preventer, must list licensed plumber. If first-time A/C, must list licensed elecbicfan.
Subcontractors: List the company namjej or 01'y of Ft Cof/lns /lcervse 4
Elect1dan Plumber M i - 5-7 Medtanfcal 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 unlit t has been paid and Issued.
Applicant'L II
Print Name: N PM ✓ i sue„ __ 5lynature _ Date