HomeMy WebLinkAbout633 Stonington Ln - Applications/Gas - Log, Line, Pipe - 04/28/2016Apr 2716 10:35p FyrePro
9702253870 p.1
City &
Flirt CoRi ` 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-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
0 Demolition (interior non-structural) ❑ Dectrical Alteration (not service change) ❑ Gas Lighter _ ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Liao , 0 Phoio-voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certitied, provide make, mode[ and
manufacturer).
Complete all applicable information on the application. incomplete applications will not be accepted_
Application # 61 u rl Date 4j
Forofiice use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address Cty/StaateZip
Phone 1�
I �j & 3 3
/
S�11J 'nJ Z-n 1AA e— FC 00
Applicant Name jd Address %..3 - LCSta - Zip
;_ phone
Contra ctor Lic Address CIVState r J _Tip/, Phone tom•
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? j2f Here ❑ Report
Sales taxnumberisreq&redbyailcon
Are you paying with your trust account?
❑ Yes Ff No
Is this a resideritial or commercial project? X Residential ❑ Commercial
If residential, is it: (3 Single Family Detached ❑ Cando/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? ❑ Yes )9.No IfyaB you may need to contact Historic Pfasenogon
If this is for a demolition permit, what year was the building constructed?
IPpnor to 1975, you will need an asbestos assassment to submit Yrith Mis application
*If lawn sprinkler/backitow preventer, must list licensed plumber. If first-time AIC, must list licensed electrician.
Subcontractors: List the company name or Giy of Ft Collins Acanse
Electrician Plumber mechanical Roofs r Other
I hereby acknowledae 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. Y know that a
permit is not valid until it has been paid and issued.
Applicant: A"'—
print 111�IR1Q;/� 1Y) I t?Signature
Date
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