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HomeMy WebLinkAbout1807 Creekwood Dr - Applications/Plumbing - 07/05/201207V05/2012 15:34 FAX Q001 City of Fort Collins 1 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 0 Heating Unit ❑ Lawn Sprinkler Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ter Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and manufacturer). , Complete all applicable Information on the application. Application # 01 o0zVTTL10-S--- For oli7ce use only Incomplete applications will not be accepted. Date ]ob Site Add (requlm) l80 Value of, Construction (labor, materials, profit) �ao� Pro rtyOwner ame Address City/S to Zip Phone l S 10.2 1 ;0 h�' Applicant Name P'an IItpt,rtC_1z= r1 Address 7yqXelYlr,y City/State Zip Phone 4'A3-1q2 Ft ('a«tY1�;CID. gts,2q qv--qc43-30F3 Contractor L I (.:• IT JYI P - r .7 Address City/State Zip Phone lvwtjipr,l Ca[crr �Y •7Hq 'a. fnx1t -9A3-142 Ft. 61165 0b. FZ).�'1 Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? )4 Here ❑ Report . sales fax number ismqulredbyall con&ad= Are you paying with your bust account? ❑ Yes )KNo Is this a residential or ardor project? , esldential ❑ Commercial If residential, Is It: Single 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 1f yam, yw maynead tb contact HLst #c 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 w(th dh/s ay#lcavon. Description of work *If lawn sprinkler/baddlaw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or plyoffr Coll/ns //tense 0 (aeculdan Plumber MedtaniCat Roofer Other I hereby adcnowledge that I have read this application and state that the above Inforinatlon 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: (� L'`^ PrintNarne: !�t ��t'►1ftC�iSE'f1 Signature 1^ Date lal