HomeMy WebLinkAbout1431 Stonehenge Dr - Applications/Plumbing - 02/22/2012City f Planning, Development & Transportation
FY O281 N. College Ave P.O. Box 580
lirt 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 ErWater Line ❑ Wood/Pellet Stove (must be EPA certified, provide -make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
For orrice use only
Date
Job Site Address (required) Value of Construction (labor; materials, profit)
/cl3/ 5Tov�lYr „/Cry 1 . Coct,�.+S Co FS�z $ 2 00cop
Property Owner Name
Address City/State
Zip
Phone
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Applicant Name
Address City/State
Zip
Phone
Contractor
Lic #a,,;jV4y,,,,Address City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account?
❑.Yes ❑ No
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Is this a residential or commercial project? ErResidential ❑ Commercial
If residential, is it: ESingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
❑ Duplex
❑ Retail
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 All--",) J,% %) i,3 >3 r7o 94 c L� +3 tar-r k T o i L r
*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 #
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 and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued. /
Applicant: G �(/ /d
Print Name:`2�/�' 2"/ Signature Date y y/� Z