HomeMy WebLinkAbout718 E Elizabeth St - Applications/Plumbing - 06/27/201206/27/2012 13:26 FAX
12001
Fort Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THEMCOUNTER PERMITS ONLY
This application Is to be used to ap ly for the following permits only (check all at apply). ❑ Air Conditioning
O Demolition (interior non-strubtural)�O Electrical Alteration (not service chi Gas Lighter ❑ Gas Log
* Heating Unit ❑ Lawn Sprinkler Mobile Home replacement ❑ Roofin , ewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater: a Water Line ❑ Wood/Pellet Stove (must be ce ed, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted. 0
QI 22
Application # LoZ J� �O off' _ Date
For olflce use orgy
,fob Site Address ( ulred)
179Z ���r J
Value of Construction (labor, malaria ,profit)
CSO
oerty Owner Name
�
Address
.1
city/state Zp Phone 990
3.,
L
V�V
Applicant Name
Pon !714R
Address
'� .LVArAy 11, R.3•-lu2.
City/State ZIP Phone
FT 911 4y3 _35
Contractor LIcr+ r ' M P- 11-7
CalGr
Address
City/state Zip ;Phone
fv'r'ilrn - 0 7y�
S.trstQtAly2
Ft, �o(IInS C'�. �k"_'.2 9 )c1��7
Contractor City of Ft. Collins sales Tax # Are you paying taxes here or by report? X Here ❑ Report
Sales tax number & required by all cnn�adws
i
Are you paying With your trust account? ❑Yes )KNo
Is this a residential or copimercW project? Ef Residential ❑ commerdal
If residential, Is It: USingle Family Detached! ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (expla1 )
Is this !wilding 50 years of age or more? ❑ Yes V No If yes, yw may need to contact Historic Preservation
If this is for a demolition perm , what year was the building constructed?
It prior to 1975, you will need a , asbestos assessment to submit w/th this app/Icatlon.
Description of work
*If lawn sprinkler/baditw
subcontrscMra: a& the ,
must list licensed plumber. If first-time A/C, must list licensed eled7ldan.
name orOty or Ft Collins /Icense .''
Mechmiml Roofer
I hereby acknowledge that I have Lead 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 Iiew paid and Wsued.
Appllcaint: /
Print Name: ► " , 'c i C tu
signare Date (o ~a2 07
-/ 9--"'