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HomeMy WebLinkAbout757 Oxford Ln - Applications/Gas - Log, Line, Pipe - 09/13/2017City of Planning, Development & Transportation FY 281 N. College Ave P.O. Box 580 6r$ CoRins Fort Collins, CO 80524 ®._ Phone 970-416-2740 Fax 224-6134 D/ER-THE-MLINTER PERMITS CNLY , s� This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning D Demolition (interior non-structural) © Electrical Alteration (not service change) 0 Gas Lighter )<Gas Log l 0 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line 0 Photo-voltalc 0 Ventilation 0 Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer) Complete all applicable Inform/anion onnthe application. Incomplete applications will not be accented. Application # Z J 14 V 54 4a Date � 1131/ -7 For office use only Job Site Address (requued) Value of Construction (labor, materials, profit) � --a 5COO Property Owner Name Address 'Clty/SXae 3e Zip Phone `�c( ls� r i! G n _ Applicant Name Address City/State Zip Phone e qco 533,4 S'imbff line: f�- `Zds o 13-17y Contractor Pho Address City/State n Zip Phoneg17() — 33 .5 Iin1 ► r Kit TCY �'01lins i Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? . Here 0 Report sales haxn ` rgaw by an contractors: Are you paying with your trust account? 0 Yes XNo Is this a residential or mmeroal protect? Residential 0 Commercial If residential, is it: Single Family Detac ed 0 Condo/townhome (single family attached) 0 Duplex 10 Multifamily (apartment) 0 Garage If commercial, is it. 0 Bank 0 Bar D Church 0 Hotel/Motel 0 Medical office 11 Office © Retail 0 Restaurant 0 Other (expI n) Is this building 50 years of age or more? 0 Yes No Ifyes, you may need to contactHistanc Preservabon If this is for a demolition permit, what year was building constructed? Ifprror to 1975, you will need an asbestos assessment to submit with this applicabon. *If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name orOtyofRCoffins ficense # 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. i Applicant: Print Name r`N� Signature -Date V#A