HomeMy WebLinkAbout1449 Ivy St - Applications/Gas - Log, Line, Pipe - 11/06/2017City Of Planning, Development & Transportation
� Ft Collins 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,�Drtditi ning
Demolition (interior non-structural) Electrical Alteration (not service change) q
Heating Unit Lawn Sprinkler Mobile Home replacement Roofingg) Gas Lighter (`'Gas Log
Ventilation Water Heater Water Line Wood/Pellet Slove (must be EPA certified, Sewer lLine
make,, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # �� 0 1-7LL Date
For office use only
)ob Site Address (required)
Value of Constructionlabor, materials, profit)
Property Ad
Owner Name ty L 0451 - 5 -7
Address City/State Zip Phone
CINeq Nelson i q C • U. glrlX,-
Applicant Name ��'5� 5 q 7&Lf
1 n Address City/State
�d'1 r f I �jY � (/ ZIP Phone
Contractor Address
Nltr�T�r2 F -
salestaxnumoerisrequiredbyal/contractors. City/State Zip Phone
E11 lsCE Si r t�l� 141Gtj K1Ji=lLs P�
Contractor City of Ft. Collins Sales Tax # F ` /Cu
Are you paying taxes here or by report? Here a or -
Are you paying with your trust account? Yes
0
Is this a residential or co eraPpro esidential I Commercial
]f residential, is it: Single Famil De
e ondo/townhome (single family attached) Duplex
Mu tlfamily (apartment) Garage p
If commercial, is it: Bank Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explai
Is this building So years of age or more? Yes No) If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the wlding constructed?
if prior to 1975, you Will need an asbestos assessment to submit with this application.
Description of work AOEQ G
JI i �r
t1 er
`[f lawn sprinkler/ back flow preventer, must ' t licensed plumber. If first time A/C, must fist licensed lectrician,
ed
Subcontra ors: Clst the'company name or Gty of Ft COilinS license a
tleancian���D dumber
---__._ Mechanical Roofer
� Other
- __1 _—.1-1�1Y= UWE i nave read this application and state that the abo eis complete and cor
formation
comply with all requirements contained herein and city ordinances and state lawsrregulating building construction cI knowethto
at a
permit is not valid until it has been paid and issued.
Applicant: •/
Print Name.A. Sj�I r
�--� Signature %r✓ 'TC u� Date tl 1 /
R