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HomeMy WebLinkAbout222 Pine St - Applications/Plumbing - 05/26/20164 3t# , z4 CityOf Planning, Development & Transportation ��rt Collins Fort N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-41616-2740 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 # T5 1 L.b2 4- • Date MAN 2 L# . 7-b I to For office use only Sob Site Address (required) Value of Construction (labor, materials, profit) r 2� ?1 i�L 1 .6 0S 2-1 '5© V Property Owner Name Address City/State Zip Phone j 32, IVLU 0_V r 9 -10 Applicant Name Add ess City/State Zip Phone &Le8466 CO O FWIV / Lyre% OS38 I b e-/12-6 n11tractorr Address e City/State 101Zip Phone t flh�� IDK�L/K.��t�rZ Contractor City o4t. Collins S es Tax # Are you paying taxes here or by report? ❑ Here eport �] Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes No Is this a residential or commercial project? ❑ Residential 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) X4 /V NL. 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. of *If lawn sprinkler/backflow preventer, must list licenseolumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City 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: Print Nam �l ba hey Signature lwt_ s Date _