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HomeMy WebLinkAbout518 Fox Glove Ct - Applications/Gas - Log, Line, Pipe - 01/09/2018City Of Planning, Development & Transportation 281 N. College Ave P.O. Box 580 F6r tl.{p ®Wns Fort Collins, CO 80524 Phone 970-416-2740 Fax 2-24-6134 CAR-THE-MJNTER PERMITS ONLY This application Is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning- 0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter )' Gas Log F_7 t 10 `J°J 0 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line 0 Photo -voltaic 0 Ventilation 0 Water Heater 0 Water Line 0 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. Z25' Z- Application # wib%M Date � Llq//� For o ce use only Job Site Address (required) Val a of Construction (labor, materials, profit) ve CT 9l4U . 40-21 Property Owner Name Address City/State Zip Phone 910 Gums t /5--ox 6toye, Cr IGrt6doI5 j}5z� a.3/'3i Applicant Name Address City/State Zip Phone e Qi,j5 533a 5.-r1Mber/.i7e R4 FT6 OS'Z d/3-79Co Contractor Address City/State Zip Phone Fy7re I�`D -1J�L 533 5 i tm �"l i �� PJ TG 8 713-79 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?X Here 0 Report Sales tax nuMrrs ui y�rrconnacrors Are you paying with your trust account? 0 Yes KNo Is this a residential or commercial project? X Residential 0 Commercial If residential, is it: ,Single Family Detached 0 Condo/townhome (single family attached) 0 Duplex 0 Mulbfamily (apartment) 0 Garage If commercial, is it: 0 Bank © Bar © Church © Hotel/Motel 0 Medical office 0 Office 0 Retail 0 Restaurant 0 Other (explain) Is this building 50 years of age or more? 0 Yes , XX o If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit wib9 this application. , Description of work 6 S n lciL d r *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license # Electrician Plumber 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 Nam.J( i e Date / Lq/ 0 1.2 -