HomeMy WebLinkAbout2502 Owl Creek Dr - Applications/Plumbing - 09/27/2019k'i•i:y01 planning, Developments & Transportation Se�noos
� CoWns Community Development & Neighborhood Services
_ 281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fax: 970.224.6134
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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 #6019V_50 Date _g9l,/ % cK-ZZ3Z
For office use oniy
Job Site Address (required) Value
lue of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone/ 5Z5
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Applicant Name Address City/State - Phone �Q�J
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Contractor Address D City/State i Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?, lere ❑ Report
sales tax nu er s i2 al/conbacfcm Are you paying with your trust account. ❑ Yes ftrNo
Is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: )'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 So years of age or more? ❑ Yes X No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
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TIf lawn sprinkler/backflow preventer, must list licens d plumber. if first- a A/C, must i st 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: q o27
! e, Signature Date
Print fVame:ylim
Revision fete 2,o12017