HomeMy WebLinkAbout515 Shadbury Ct - Applications/Plumbing - 12/22/2017c,Ciity of - ' Pianning, Deveiopmen4 & Transportation Services
Collins rt olCommunity 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 O Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA c_ ertifled, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ) �� �� �i Date a � a L 1 I �
For ofte use on/y
lob Site Address (required) Value of Co r ct9on (labor, materials, profit)
51 S `—
Property Owner Name Address atV/State Zip Phone
141S �o5as - -
Applicant Name - Address City/State Zip Phone
S± 1) Ua 19_a
Contractor Address City/State Zip Phone
u 0teS,2D5,A1 T 7 a
Contractor City of Ft. Ilins sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales ftrwmdarisregroredbyapazmacmrm Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial -
If residential, is it j Single Family ❑ Condo/t ownhome (single family attached) ❑ Duplex
�j Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes O No If yes, you mayneed m conta&His c Pregervabbn
If this is for a demolition permit, what year was the building constructed?
Descriptioq of work ' «
d t
*If lawn sprinMer/baddlow prevenber, must list licensed plumber. If first-time A/C, must list licensed electHcian.
Subcontractors: List the company name or City offtCollins /iaense#
Elearidan Plumber Medankal - 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 riot valid until it has been paid and issued.
Applicant: �n�,
Print Name: Signature414 11 . Date
Rwis date ZIGM17