HomeMy WebLinkAbout4431 Stoney Creek Dr - Applications/Plumbing - 11/18/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
' 281 North College Avenue
Fort Collins, CO 80524 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 # 3 n D (zl3e),4 Date /11
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
qql Sbn ve f , ai li C0 ems' q 364
Property Owner Name Address City/State Zip Phone
T ne y 31 5 Qe& Mw-, F¢, C hl 3 (.v 05.-2�
Applicant Name Address City/State Zip Phone
em CMM 1&17 F. A4u)Wr.-q 5. F'f. 9Zo
Contractor Address City/State Zip Phone
f m CO IILMbJrait' 161-7 E �cr • PT (el if/1s 895as ft-`7'0
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here T$ Report
Sales tax number is required by all contractors. Are you paying with your trust account? 9L.Yes ❑ No
Is this a residential or commercial project? g Residential ❑ Commercial
If residential, is it: )o 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 more? ❑ Yes ❑ No 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 e "�
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber A F —S7 1 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 Name ��� gwo' Signature 2�// ZZ4 1Date %�/�a//�
Revision date 2/62017