HomeMy WebLinkAbout3206 Red Mountain Ct - Applications/Gas - Log, Line, Pipe - 09/12/2017City of Planning, Development, & Transportation Services
Fort Cothns Community Development & Neighborhood Services
261 North College Avenue
Fort Collins, CO 60524 Main 970 416 2740 Fax 970 224 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-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ 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
Application # f-bn652qr-" Date Z • n
For offce use only
]ob Site Address (mqutred) Value of Construction (labor, materials, profit)
Pro rty Owner Name Address City/State Zip Phone
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Applica t Name Address Gty/State Zip Phone
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contractor r Address Gty/State Zip Phone
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Contractor city of Ft Collins Sales TcW# Are you paying taxes here or by report? ❑ Here Report
Saler tax number ks rtqunedby as mn6adws Are you paying with your trust account? ❑ Yes N0
Is this a residential or commercial project? IZ..,Residential ❑ Commercial
If residential, is it, -Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ 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 morel ❑ Yesplft if yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
Description of work 19y'DV i , / ) -rIC t(q Wltj -% t G 1 n SL 7 f I i ��o S --irei Gr ce
(�nr�n o ri' -►n _� I �+Lra any 11 nz
*If lawn spdnkler/back low preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: Ust the company name or Oty of rt Collins license #
Electrician 1e 'i,'✓ t e, 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:
Print Nam SignatuR 5`U"( Date
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