HomeMy WebLinkAbout301 Garfield St - Applications/Plumbing - 12/19/2017Dec 19 1712 58p Northern Colorado Plumbin 970-221-0879 p 6
Planning, Development, & Transportation Services
FOrt Coltlns 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 6d Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line Cl Wood/Pellet Stove (must be EPA certified, prowde make, model and
manufacturer)
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application #y \-1 C) 00-1 a-C) Date f ghq/ 7
For of be use only
]ob Site Address (regmred) Value of Construction (labor, materials, profit)
0st• co 805;k.9
Property Owner Name Address City/state Zip Phone
Applicant Name Address CrtY/Sta Zip Phon�e�y�y
Y roz L b Via. q�olo�fi3�
Contractor JAddress ty/State Zip Phone
i tl 1 sr of -q
Contractor City of Ft Collins les Tax # Are you paying taxes here or by report? ❑ Here 0 geport
Sales lax nurrrberIs repmred by all aon&adom Are you paying with your trust account? ❑ Yes EdNo
Is this a residential or co mercial project? Residenbal ❑ Commercial
If residential, is it: VSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifanuly (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this budding 50 years of age or morel ❑ Yes ❑ No Ifyms you mayneed to contactHistolwPresarvabon
If this is for a demolition permit, what year was the budding constructed?
Description of work ?Wei pine CiC
*If lawn sprinkler/backfkna preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Su bcontractors: List the company name or City o(faFt Collins hca #
Electrician Plumber �`P—S11 hted,anua3 Roofs Other
I hereby admowledge that I have read this application and state that the above mformabon is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating budding construction I know that a
permit is not valid until it has been paid and issued.
Print Name, ►'IIC�1l2 "Gtlll(tSignature r 1 Date fa/%y /-7
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