HomeMy WebLinkAbout705 Eastdale Dr - Applications/Plumbing - 11/27/2017.fyip/ tins
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
Dt7wlitlon (intanorrion-structural) ❑ Electrical Alteration (not service chap e) ❑ Gas lighter ❑ Gas Log
rl Nea[Ing Unit ❑ tewHeater ❑Water Line Home
❑ Wood/Pellet Stov❑e mou t be certified, provide make, model anti
CI Ventilation [IWa
manufacturer)
Complete all applicable information on tlhe, application. Incomplete applications will not be accepted.
Application #
W Date �11 V7 \i _
Fnr a ce use only —
Job Sits Address (required)
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Property Owner Name Address
RCL
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+ Applicant Name, Address
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f Contractor, Address
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Contlzctor CRY of Ft. Collins Sales Tax #
:�;:s tag numbarls rzqurred by all mnbactors
i lI�JSi�/1 —
Planningr Development &c Transportation
281 N. College Ave P.O. Box S80
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
Valve of Constrvcbon (labor, materials, profit)
51%4 '$ 1 � I'�'l q , W
City/State Zip t Phone
City/State ip Phone
f'�. 60 S05all 1140-41192
City/State Zip Phone
- .VM.A
Are you paying taxes here or by report? ❑ Here ' gRepol t
Are you paying with your trust account? Y,Yes ❑ No
Is esi aresidential o commercial project? Q Condo/townhome (single idendal El Commercial ngle Family attached) ❑ Duplex �
IF residential, is it: Ingle Family Detach r
❑ Multrfamily (apartment) C] Garage
it commercial, is it. ❑ Bank ❑ Bar Q Church ❑ Hotel/Motel ❑Medical office Q Office El Retail
Q Restaurant ❑ Other (explain)
Is this building
50 years of ago or morel ❑ Yes ❑ No If yes, you may need to contact HistoricPreservatfOn i
demolition permit, what year was the buliding constructed?
If Lltis is for a I
you will need an asbestos assessment to submit with this application.
If pnor to 197
Description of work .T
'-If lawn sprinkler/backflow preventer, must fist licensed plumber. Ir first-time A/C, must Ilst licensed electrician
Subcontractors: List the mmpanynameorCry ofFtCollInsAcense# Other
i L'lotinaanPl
_ ___ —
Number Mechanical Roorer —
f hereby acknowledge that I have read this application and slate that the above information is complete and correct. I agree to
comply with all i equirements contained herein and city ordinances and state laws regulating building construction I lmow that a
permit is not valid until it has been paid and issued.
'pr/A1 !
P Applicant: nt IVa ne.,� !i►� 1 and sr��atvre,� �,. - w t i X7 i %_