HomeMy WebLinkAbout4560 Seaboard Ln - Applications/Plumbing - 09/18/2019Cityof Planning, Development, & Transportation Services
Flirt liras Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 ❑ 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 # � 1 "I � 1 1 Date �1 9
For office use only
Job Site Address (required) \ Value of Construction (labor, materials, profit)
L16_0 SegkioQr Ur, rf.6-AliN Crv aC' bSRS "C U 1'�
Property Owner Name Address City/State Zip Phone
�147 rLrte Car Ser-60e%j Lr., Ft•Glf.IVS CD -16S2,5-
Apnlicant Name Address City/State E052 5' Zip Phone
Contractor Address City/State Zip 6aD526 Phone q7o _
i i oo Z- i 0Z -MI
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here &eport
Saks tax number is required by allconbactors. Are you paying with your trust account? AYes UNo
'AMZD
Is this a residential or commercial project? ®.Residential ❑ Commercial
If residential, is it: P Single 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 Ifyes, you may need to contact Historic Preservaifon
If this is for a demolition permit, what year was the building constructed?
Description of work Ref W-st-er1•lnc in- sAc rcA fiFCrx S� eP cf0�� l 4 �eOT�re_
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: L& the company name or Qy 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 knows that a
permit is not valid until it has been paid and issued.
Applicant:
2 Q'i Wl ck� L ui it 9 �l� %
Print Name _ _ signature _ Date
Revision dale 2/612017 (,