HomeMy WebLinkAbout1217 Columbine Ct - Applications/Plumbing - 08/21/2018City of Planning, Development, & Transportation Services
FOrt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY y
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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 ewer 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 #
For office use only
Incomplete applications will not be accepted.
Date LZI I �
Job Site Address (required) Value of Construction (labor, materials, profit)
['217 6o(vrrib`IU L-(, Fk. (I' c 1-71• vu
Property Owner Name Address City/State Zip Phone
Jo Lck.5� 970 -e/kY
Applicant Name Address City/State Zip Phone
d > kA `c .eq) Nlct nolic, S1 . FA , 601 k,) zz lo�s�
Contractor Address City/State Zip Phone q76 -
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? KHere ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes >' No
Is this a residential or co mercial project? esidential ❑Commercial
If residential, is it: Single Family Detached ElCondo/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? ❑ YesxNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work c>eu.I..c \ n.
*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
Collins license #
Electrician Plumber h P-. -(7/ 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: �1 p
Print Name:�Signatur Date 2/ /
Revision date 21612017
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