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HomeMy WebLinkAbout1020 Sailors Reef - Applications/Gas - Log, Line, Pipe - 08/10/2017Planning, Development & Transportation r =C' �Y n 281 N. College Ave P.O. fox 580 t •.V jv, fiFort Collins, CO 80524 �� =—q� Phone 970-416-2740 Fax 224-6134 R-THE-C NTER PERM 0 ITS CNLY This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning � 0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter A� Gas Leg77 Se r 0 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing' 0 Sewer Line 0 Photo -voltaic _ 0 Ventilation 0 Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information o the app�licajtion. Incomplete applications will not be acccelpted. Application # t5l ���� T Date Pp For ofrice use only Job Site Address (required) Value of Construction (I or, materials, profit) saD o D © ."Al r eel'�� Property Owner Name Address City/State Zip Phone 70 e►- rn Ael D aW 6d//ors &f=EC, CD 2aS,z�7 dMF 7 Applicant Name Address Zip !Ciity�/State C7Phone 2G)'r77d(�' :l�Ll L S 531/ nlb'U' lllle t`U� fL'rtCt'�l f!'i5 �r�GSr—G` c�/J'� Contractor Address City/State Zip Phoneggjj, — at3' �, /I , LED . ZAJL Iri 533 ,S."T,ahr- r,le-1�=1 �Z, r , iLrl Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here 0 Report Sales tax nu_r�beri;r�qui by all contactors. Are you paying with your trust account? 0 Yes KNo is this a residential or commercial project? XResidential 0 Commercial if residential, is it: KSingle Family Detached 0 Condo/townhome (single family attached) 0 Duplex 0 Multifamily (apartment) 0 Garage If commercial, is it: 0 Bank 0 Bar 0 Church 0 Hotel/Motel 0 Medical office 0 Office 0 Retail 0 Restaurant 0 Other (explain) Is this building 50 years of age or more? 0 Yes -KNo If yes, you may need to contactHlstonc Preservation If this is for a demolition permit, what year was the building constructed? Ifprior to 1975, you will need an asbestos assessment to submit with this application. Description of work a6 "if lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or Gty of a 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� J l Print Nams �es / ' / G 11DA4A— Date