HomeMy WebLinkAbout2718 Beaver Ct - Applications/Gas - Log, Line, Pipe - 02/09/2016Feb 08 16 10:03p FyrePro 9702253870 p.1
planning, Devel®pmc-nt T rarlsPlIftatlort
OtNfcye 281 N. College Ave P.O. Box 580
Foil CO b ns Fort Collins, CO 8052E
Phone 970-416-2740 Fax 224-6134
OVER-THE-CGOUNTER 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 F+
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line, 0 Photo -voltaic
❑ Ventilation D Water Hewer ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information an the application. incomplete applications will not. be accepted.
Application # 9I @ Q 0 (O&SS _ Date
For of-rce use only
mob Site Address (required)
Property Owner Name
`lIN I r..i / 't i .-I i .l
Applicant Name
Contractor, Uc
i .. j�` .,_�_.�� � �" � •� '.-yam :' ` �-._ .•�
F-
Vague
of Construction (labor, materials, profit)
Address City/State Zip Phone
_ Address f City/State Zip
o
Address City/State Zip:;
Contractor City of Ft. Collins Sales Tax
5ales tax number is required by all contSactQLS
Phone
Phone;
Are you paying taxes here or by report? ,K Here D Repor
Are you paying with your trust account? D Yes ,4 No
Is this a residential or commercial project? XResidenflal ❑ Commercial
If residential, is it: k Single Family Detached ElCondo/townhome (single family attached) ❑Duplex
❑ Miuldfamily (apartment) ❑ Garage
If commercial, is it: I❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel El Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building Ejo years o age or more? ❑ Yes XNo Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ii prior to 975, you Y✓ill need an asbestos assessment to submit with this application.
Description of work
CGi
"If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
SL: bco.qt, ac ors: List the company name or City of Ft Collins license r
Electrician
Plumber Mechanical Roofer _ Other
I hereby acicnowledge 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. ? know that a
permit: is not valid until it has been paid and issued.
-Iql
;,vpPlicandt: [ 4.. i ::ll l lw`(�.. Datepii lint Name, � l (I 11(�_! � signature —
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