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HomeMy WebLinkAbout500 Louise Ln - Applications/Gas - Log, Line, Pipe - 08/02/2016it V ®z of CoUl a ds .lanniing, Development 1L Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-41 6-2740 Fax 224-6134 OVER=THE-C O UNTER PERMITS ON LY This application is to be used to apply for the following permits only (check all Thai apply). 0 Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter _0 Gas ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Lime., 0 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. Applicabon T ?m1 LL0 - Le. Date For once use only job Sane Address (required) value or Consi r'uLtign, (labor, materials, profit) Property Owner Name Address City/State Zip Phone r � �Zn,� �rt�r/�12s C� 1 ,z.t 4AI- �3i1 Applicant Name _ Address ' �-- City/State Zip _ Phone v'j"Ou i jS ;-7-S'- Ctl'actor� Lit T Address , -, �i- City/State �^ �. Zip:_' / Phone :-�' J� � • ��. �$ 11 'X ° r,- -� 1 ' J - i Li L- E Si�.. Z 1 i r� , . r V i! t f J-i Contractor City of Ft. Collins Sales Tax E Are you paying taxes here or by report? 0 Here ❑ Report . Sales tax number is required by allconaactgrs_ _ Are you paying with your trust account? ❑ Yes ❑ No P-76' Is this a residential or commercial project? 0 Residential ❑ Commercial If residential, !sit: ,CZ 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 50 years ®S age or more? ❑Yes 0 No lfyes, you may need ro contact Historic Preservation if this is for a demoliti®n per nni€, what year was the building constructed? ifprior to 1975, you w111 need an asbestos assessment to submit with this application. Description of -work ' If lawn spridder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Saabcontrackora: List the companyname or Cry of It Collins license Elecsidan 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. X know that a permit: is not valid untiull it has been paid and issued. Applicant. �, %�•��� p int mame&Jd ml P -Signature( y ©ate