HomeMy WebLinkAbout218 Smokey St - Applications/Plumbing - 12/08/2017City of Planning,• Development, & Transportation Services
F, 6rt 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 Clot taoAP
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 Spnnkler ❑ 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 # iit q)36 t Date
For ofte use only ' `'
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
5 Ay;& - 7 r-. Co G0 65 zS 1770 _ -�2$a' (( a
Applicant Name Address City/State Zip Phone
Atiin6 e4 Rain Aellf. CoA24 (.o W5267 170
Contractor Address ity/State Zip Phone
&Z 6: MLL4223i 2. EL 60AL15, CD T 70
Contractor City of Ft. Collins Sales Tax # Are you aymg taxes here or by report? ❑ Here fX Report
Sa/es tax number Is required by allmntactois Are you paying with your trust account? )V Yes ❑ No
Is this a residential or commercial project? CjLResidenbal ❑ Commercial
If residential, is it: 95LSingle 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) 'Gkiff\C 4n�-"
Is this building 50 years of age or mor 7 ❑ 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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Ci y of Ft Collins license #
Electrician Plumber MP-51� 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-r o SJgnature Date
JR
73
Rewaon date 2/6/2017