HomeMy WebLinkAbout2218 Stoney Pine Ct - Applications/Plumbing - 12/19/2017Dec 191712.58p Northern Colorado Plumbin
_970-221-0879 - p.5
FO` iPlanning, Development, & Transportation Services
t � 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 seance change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit r} Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation .eater Heater "ater Line O 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� �`1C' _ Date W1 R 11 7
For ofnce use only
Job Site Address (mquimv9 Value of Construction (labor, materials, profit)
9949 516n `Erl -S- 21Y
Property Owner Narrk Address City/State Zip Phone
Rd fli rli a- Sfo Poe- � $d5 gZ-a19�
Applicant Name Address City/State Zip Phone
n b `� tivl-7 ul 64, & C'dG GD Bt�sa�F y'7a-
Contractor Address Gty/State Zip Phone
n 5{. f05/ y8�
Contractor City of R. Collins tales Tax* Are you 4ying taxes here or by report? ❑ Here ❑ RR port
-%* s ra r number Is,egt*ed by aH mrwacWm Are you paying with your trust account? ❑ Yes l� 0
Is this a residential or commercial projects 1l�Residen ial ❑ Commercial
If residential, is it ED,! ingle 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 contactHistvrk Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work L.1 i
*If lawn spnnkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty oofFt Collins 11cw7se #
EtecbriM Ycian Plumber — :5-19 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: (�111 - Signature i Lr4 Date / o9 /igh7
Rev�on min Zazov '