HomeMy WebLinkAbout2005 W Plum St - Applications/Plumbing - 01/08/2015Fort of
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
❑ 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. Incomplete applications will not be accepted.
Application # Date
For office use only
Job Site Address (required)
Value of Construction (labor, materia
profit)
-200 T WesT Pk/0
ForT LolhS 49 dos"Z/
2 - 300,00
Property Owner Name Address
City/State Zip
Phone
V; II a of 1�IdM LLLP 7 1 —
v Moonr. rA Ave Pori L'oll�� ((�
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Applicant Name Address
City/State Zip
Phone
5404,lbr.cl e , . 7Cs0 /Ks-490
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
MrMultifamily (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 prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work 4C b
re Pell, / of .4PPooX,,
3 inc1ol A.+-t1isA Si4W UIgi45.
*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 Plumber A r ^ O Z 5 Mechanical Roofer
Other
Z 4-
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: I I ' j� �{
Print Name: j WI I •AM M/ . !&I J((O signature Date