HomeMy WebLinkAbout3815 Oak Shadow Way - Applications/Plumbing - 06/05/2014t Collins
Planning, Development & Transportation
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 (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
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # W \`kWdr65S
For ofce use only
Date G IS /20 l y
Job Site Address (required)
Value of Construction (labor, materials, pro
381 Oal.< 5-vIOLLC"' Wa I c> +
C) 96S2V
4 7 -614 =2443
Property Owner Name Address
City/State Zip
Phone
S V"OS ctv,d 1,c 39IS Oo.L
91.,wdoc.4/w S4 Fq, (al l;n Co
&qsz �4cf-e4i
Applicant Name Address
City/State Zip
Phone 249 3
3cw40 S '13 cu n sot -IQ ct s
0.10u
Contractor Address
City/State Zip
Phone
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
Is this a residential or commercial project? 3 Residential ❑ Commercial
If residential, is it: Ysingle Family Detached ❑ Cando/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 o 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 its WV -�'� �� our la..d Sc4g,k2q wa neon 4b CL>, k n a.✓ of i
*If lawn sprinkler/bacTcflow 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: j L L/
Print Name: J OLVInOS 3%aZ� 1 10✓I Signature / Date S 2 l /