HomeMy WebLinkAbout1717 Deweese St - Applications/Gas - Log, Line, Pipe - 09/23/2016FCity of Planning, Development & Transportation
(5rt Colons 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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OVER-THE-COUNTER PERMIT'S ONLY I
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 change) Gas Lighr "'Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Phoo �rolta c--•'{
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Ventilation Water Heater Water Line Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the aappli ation. Incomplete applications will not be accepted.
Application # I V� J
Date at2ufflaL J-For office use only I U I l�
]ob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name o a t 35 D b
Address City/State
ZIP Phone
��1ti�L5 i ST
A plicant N rye Address it �2�
"n..�,�� City/State Zip Phone
Contractor Address
Uv �z:, d �_:iLt�i � ltz. c• � CIS/State Zip Phone
t't !tip F'i L i L+O,e•-i k�, a�
�is9J� t� 'F_d-•/Liu `,C/524 S
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? I�e�ort
Sa/estaxnumberisrequiredbya/lcortractors Here
Are you paying with your trust account? Yes No
Is this a residential or commercial pr ' ? esidentiaL�
If residential, is it: Lingle Family —et-ached Commercial
y Condo/townhome (single family attached) Duplex
apa ment) 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 'IS' If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the wilding constructed?
"prior to 1975, you will need an asbestos assessment to submit with this application.
of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subconkrz ors: List the company name or City of Ft Collins license .#
Electrician +1 C{
PlumberC_- Mechanical �—
Roofer they
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. II know that a
permit is not valid until it has been paid and issued.
Applicant: r��I
Print hlaane(� V (�/
—/_ Signature
Date