HomeMy WebLinkAbout3533 Sunflower Way - Applications/Gas - Log, Line, Pipe - 08/29/2019ri y or pp Planning., DeMopment, & �'ranspoda aon Services
6rt CoWns Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80824 Main: 970.416.2740 Fax: 970.224.6134
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 { eg F.• ylti
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodiPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Q�A� «I Date Zf92 //9
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
3535 'Cl v wex- Glfa. $�3v� . O v
Property Owner Name Address City/State Zip Phone�/7D
/ ! at5L- .353.3 'Sur) -plower Ufa Gr-t' Co I'. (i•z5 577-232'
Applicant Name Address City/State - e CQ3z�
CoAtractor Address J;` C%State Zip Phone G17D
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report
Sales tax er s he 11 contractors Are you paying with your trust account. ❑ Yes s)Pft
Is this a residential or commercial project? gResidenbal ❑ 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 So years of age or more? ❑ Yes JKNo If yes, you may need to contactHlstoricPreservation
If this is for a demolition permit, what year was the building constructed?
Description of work &MO ✓G e Y ( Gt— -�r ✓L p �' r �J r E—�
/1 ZuJ r
If lawn sprinkler/backflow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Crty of Ft Collins license #
Electrician Plumber 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: jam Date � 2
Print name. [ e� Signature
Revision dale 21612017