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HomeMy WebLinkAbout4542 Maxwell Dr - Applications/Gas - Log, Line, Pipe - 03/31/2015Mar31 1511:44a Hahn plumbing 970-493-6325 p.1 City of Fes$ Coat s Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER -THE -COULTER 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 LighterGas Log CI Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement E3 Roofing ❑ Sewer Line . ❑Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Wader 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. 07 Application # 15 0 oZ3 i Date For oliFte use only Sob Site Address (required) Value of Construction (labor, materials, profit) ll J Property Owner Name Address City/State Zip 1 . - Phone f J Y cQSL 11 ! 1A,, 1l:L n Applicant Name Address City/State Zip Phone 1 hima 130 C - 96 Contractor J Address City/State Zip Phone k�. h . Contractor City of Ft. Collins SAs Tax # fYtp- /S sakes by Are you paying taxes here or by report? 13 Here Are paying with your trust account? 9 Yes gReport ❑ No lac aumberlarequlred all caabacmm l/) '-) -A you Is this a residential or mmerclal project? NA Residential ❑ Commercial If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) Cl Duplex 13 Multifamily (apartment) ❑ Garage ' If commercial, is it: Cl Bank ❑ Bar ❑ Church ❑ Hobel/Mobel © Medial office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? 0 Yes Cl No Ifyes, you mayneed to contactHistorfcPrewrvabron If this Is for a demolition permit, what year was the building constructed? a• prior to 39731 you will ached an asbaFWs asszssment to submit with this appHcailon, Descripklon of work !` {-n 6' l r' r- (r . l y n e "' 4 *If lawn sprink)ar/backii preventer, m list licensed plumber. flr#me A/C, must list licensed electrician. Subcontractors: List 1hecompanyname orCtyofFtCOMM h wseig Elert iciaPlumber. Mechardcdt 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 taws regulating building construction. i know that a permit is not valid until it has been paid and issued. Applicant„ { Print Name: P/L _ S('.i 1 Signatura