HomeMy WebLinkAbout6014 Snowy Creek Dr - Applications/Gas - Log, Line, Pipe - 06/25/2012Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
FOrt 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 XGas 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.
Application # i� � _ 3 9'3 S'
Fo office use only
Incomplete applications will not be accepted.
Date /0-19-5—)02
Job SiteAddress (required) r Value of Construction (labor, materials, profit)
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Property Owner Name Address
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City/State
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Zip
Phone
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Applicant Name Address
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City/State
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Phone.
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Contractor Lic # Address
City/State
Zip
Phone
Fc7-1711
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or
by report?
XHere ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes V No
Is this a residential or mmercial project? P Residential ElCommercial
If residential, is it: aSingle Family Detached ❑ Condo/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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If plior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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
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 '—//2
Print Name: k" iieA �` Signature Date a5