HomeMy WebLinkAbout6318 Buchanan St - Applications/Plumbing - 09/12/2017�p 06 17,07:36p ellmann service compony
of
F®rt Collins
970-482-0416 p.1
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑. Demolition (interior non-SbUctural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer lane ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater.RfWater Line ❑ Wood/Pellet Stove (must be EPA oertified, provide make, model and
manufacturer).
Complete all applicable information on the application. incomplete applications w81 not be accepted.
Application # 15 1 q 0-34 4 Z
For ofAce use or*
Date q - (a - / -�
]cab Site Address (1wuned) Value of Construction (labor, materials, profit)
28 z1?. 3(o
,8ro�� YOw�n ► me Address(O'N City/State�a+r4— Zap Phone
coffins. Co SAS
Applicant Name Address City/State Zap Phone 970
�;om"t WCZ4 CYO CSK-F n V4 2Z3-
Contractor p- /I Address City/State .Zap Phone
any c / u�' ce�Z
Contractor City of FL Collins Sales Tax Are you paying taxes here or by report? ❑ here ❑ Report
Sales raxnumberrrreyurrfdbya#mntrarm s Are you paying with your trust account%, ^ es ❑ No
Is this a residential or commercial project Residential ❑ Commercial
If residential, is it Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: 0 Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
0 Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No &yes, you mayneed to con= KstoricPres&vabon
If this is for a demolition permit, what year was the building construcbed7
Ifprdor to 1975, you w17f need an asbaslns asmwnent to submit wiGir this apprirai3ar7.
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*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must fist licensed ern.
Subcontractors: List the company name or Gty of Ft Cofts rrcense #
Electrician Plumber Mechanical Roofer
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.