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HomeMy WebLinkAbout3249 Rookery Rd - Applications/Gas - Log, Line, Pipe - 09/05/2017City of Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 i l: : 'Hart Ti ! ►.ill :1 / iEs i;l► l This application is to be used to apply for the following permits only (check all that apply). © r Conditioning hter 0 Demolition (Interior non-structural) 0 Electrical Alteration (not service change) 0 Gas LigA'Gas Leg F�'rer) - 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 on the application. Incomplete applications will not be accepted 'lr Application # 116n ) For office use only Job Site Addr s (required) of Construction (labor jnatehals, profit) if �(� i? rN!�/• �U�O• Property Owner Name Address City/State Zip Phone r l ` ly r 52Z11 e�66*vRi FTF, CD P520 OX - ,7 Applicant Name Address City/State Zip Phone ) -f f:Li GI _ S 3 S `'mb�'(,ne illC�tCvlli�s 7U5�g �13-7ti Contractor Address City/State Zip Phoneggj) — 12 C I-� ° i �3 5 Iin1lx+rrr12/4� lZli(Allc/L5 i1�1' Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? XHere 0 Report Sales tax nurrlb-=r„E�by all contactors Are you paying with your trust account? © Yes ,)(No is this a residential or commercial project? 4itesidenbal 0 Commercial If residential, is it: �3ingle 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 —4<_No Ifyes, you may need to contactH/stonc Preservation If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you wll need an asbestos assessment to submit with this application. i►.R.Ti7 *If lawn sprinkler/back low preventer, must list licensed plumber. If first-bme A/C, must list licensed electrician Subcontractors: List the company name or City offtCollmslicense# 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: c� )/G Print Name. Date aL-