HomeMy WebLinkAbout1925 Etton Dr - Applications/Gas - Log, Line, Pipe - 07/29/2016FCity Of Planning, Development & Transportation
(5rt Co fts 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THR-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply).
Demolition (interior non-structural) Electrical Alteration (not service thane pg to "'ba.. Log q k
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Ph��va"
g) Gas Lighter ('Gas Log
Ventilation Water Heater Water Line Wood/Pellet Stove (must be EPA certified, provide make' miodel and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
For office use only Date
Sob Site Address (required)
(ii '�/� (��,�, Value of Construction (labor, materials, profit)
l �l ������ rpl�1 4
Property Owner 11 Name �- � i ` •. e ! Address City/State
Zip Phone
Applicant Name ` G A �dress
Ci ; �� ,✓Lt _ ty/State Zip Phone
Contractor Address
City/State p
c.; d- i�.+v s-t..`-•,.c:_ `'=:.F'I? i�-I iP ;:, _ Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors Are you paying taxes here or by report? Here
a e; Are you paying with your trust account? Yes No ort
Is this a residential or commercial project? sidentiiaall I Commercial
If residential, is it: Single Family Detache o�ndo/townhome (single family attached) Duplex
M°f'�jty; r�r ent Garage p
If commercial, is it: Bank Bar Church Hotel/Motel Medical office
Restaurant Other (explain)_. Office Retail .
Is this building 5o years of age or more? Yes No ��f yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was thlcTng constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of,work _� NCB lA l� ,-L ,l",l'
#If lawn sprinkler/backflow prey Inter,must list licensed. Plumber, If first-time A/C, must list licensed electri
` '1r' ,Y1 j
Subcontractors: List the company name or City ofF'Co//ins license clan.
Electrician Plumber
Mechanical _ Roofer
Other
I hereby acknowledge that I have read this application and state that the above information is complete a
comply with all requirements contained herein and city;oidinances. and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued. p nd correct. I agree to
Applicant: jn S �t V"v t`
Print Ni C- ! ,,F -( 1.
Signature ��'A :•�;—
Date