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Home My WebLink About5406 Fossil Ridge Dr E - Applications/Plumbing - 11/14/2011, 'City of Planning, Development & Transportation 281 N. College Ave P.O. Box 580 F®rt Collins Fort Collins, CO 80524 Phone 97"16-V40 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) [3 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit O 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 # 9 l 1 1 C L450 Date Miry ,%11 OS. U 1 For office use only Job Site Address (required) Value of Construction (labor, materials, profit) Property Owner Name Address r City/State Zip Phone Name Address 03- iya Clty/State Zip Phone n I A .. r Contractor Uc # Address City/State Zip Phone L7, GYP-7� Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?' IZ Here. ❑ Report .sales tax number Is required by all c»nbadors. Are you paying with your trust dccount7 ❑ Yes. JA No Is this a residential or commercial project? M Residentiil ❑ Commercial If residential, is It: 60 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex 13 Multifamily (apartment) ❑ Garage If commercial, Is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain). Is this building 50 years of age or more? 17 Yes Q No If yes, you may need to contact Historic Piesematlon If this is for a demolition permit, what year was the building constructed? Ifmor to 1975, you will need an asbestos assessment to submit Wth fls appllcation. Description of work *If lawn sprinkler/bac0ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or. Gty 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: Print Name: �� Pw{ ,r M _Signature //2 �� 1--- Date ly L /L # bCLWNL6 SS LULL-SI-LL /10/2009/FRI 10:15 AM Development Review FAX No•970-224-6134 P. 001/001 City of Planning, Development & Transportation '+ 281 N. College Ave P.O. Box 580 , F6rt CottinS Fort Collins, CO 60524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This appilbetion Is to be uaed to apply for the following permits only (check all that apply). O Air Conditioning ❑ Demolition (interior non-structural), ❑ Electd6al Alteration (not service change) O Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinider ❑ 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 app[icabl information on the applicatlom Incomplete applications will not be accepted. Application #, I ( ccc C/ Date For oRFcv use obty Sob Site Address (n9 amd) , , Value of Construction (Iao , material�(rofit) ' $ g}7o ® / Properly Owner Name \Address City/State Zip / i o Phone J313 pllcant Name • Address #3_ i4A City/State j ail Phone e r'chS , �,AYV. Milos CCL' QeA T 3G Contractor lic # Address City/State % Tip. e Phone .S n Q- ire A 970-A01 - 168 Contractor City of Ft, Collins Sales Tax # Are you,payfnng taxes here or by report? 'q Here ❑ Report r++nr+ w&ra7aredbyasaaraaemm Are paynn`g with your trust account? ❑ Yes NNo . Is this a residential or commercial project? Residential 0 Commensal If residential, Is It 21.51ngle Family Douched O ¢ondo/townhome (single f Imlly attached) O Duplex . ❑ MuWamily (apartment) 0 Garage '11 TP mmmerctal, Is R: ❑ Bank ,17 Bar ❑ Chu Hotel/Motel 0 Medical office Office ❑ Retail 0 Restaurant O O r (explain) Is this building 50 years of age or morel CI Yes $(N D` yes, YOU may need to contact Njxon'c Preservabbn If this Is fbr a demordion it, year was the building consbuctE:d? -ffP/tr to 197s, you wl//neck an a assiaswnent io submit with ffi& app/kat/an. Description of work V lawn sprinkler/backnow preventer, must list 11censed plumber. IF first-time A/C, must list licensed electrician. Subcontractors., Ust the company name or Qty of ft Col/ins #Cease # Vedridw. Plumber Medtankal Roofer Other I hereby 8cknowledgq that I have read this application and smte that the above Information is complete and correct, I agree to . Comply with all requirements contained herein and city. ordinances acid state laws regulating building construction. Y.know thata permit N not valid until it has been paid and Issued. Appllpn�G� C� Una7��— PrintName: rt '��11 SignatureDate l /l # tCtWNL6 : 9b EZ:II-bl-ll