HomeMy WebLinkAbout2206 Coventry Ct - Applications/Plumbing - 12/19/2017Dec 19 17 12 57p Northern Colorado Plumbin
970-221-0879 p 2
Planning, Development, & Transportation Services
!,Fort Collins Community Development & Neighborhood Services
ft 281 North College Avenue
Fort Collins, CO 80524 Main: 970 4162740 Fax 970224.6134
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) ❑ Electncal Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 06ster 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 # 1)11y� I 1 Date 1�111 / (?
For office use only
Job Site Address (requo-ed) Value of Construction (labor, materials, profit)
Imo n,4wv�-
Property Owner Name Address City/State Zip Phone
mk ck Clem (D ' sns
Applicant Name
�' Address City/State Zip Phone
Contractor Address City/State Zip Phone�
n • Sud rdJ Srs -73
Contractor City of Ft. Collins Sd6s Tax # Are you paybig taxes here or by report? ❑ Here ❑ Report
.files&wnwnbertsregUkedayaaaon&actnrs. Are you paying with your trust account? ❑ Yes Ed"No
Is this a residential or�copmeraal project? �ssidential ❑ Commercial
If residential, is it: UYSingle 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 O No If yes, you may need to contact lAsinr/c Preservation
If this is for a demolition penult, what year was the building constructed?
Description of work je--
*If lawn spnnkler/baci flow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or Gtyy of Ft Collins Ctense #
Electrician Plurnber e `� I -I 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. Lin 1 - aAHsignaty Date %a-%1 y %17
Rmafon date 2 Y2017