HomeMy WebLinkAbout630 S Grant Ave - Applications/Plumbing - 12/02/2019City f Planning, Development & Transportation
Fry o281 N. College Ave P.O. Box 580
o1 t Collins Fort Collins, CO 80524
/ Phone 970-416-2740 Fax 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove
(must be EPA certified, provide make, model and manufacturer).
Complete all applica of atiioQn o the a�,p!plli tion. Incomplete applications will not be accepted.
Application # I l T "` 3 `o Date
rr For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone
Applicant Name /� Address
�-f,' 4e U' ; ti' pA6n 5baOrr, 31,.6
City/State Zip
4,0 5¢e-c-s 6v i�G 136
Phone
% - 6Gz-t-1751
Contractor
Address
City/State Zip
Phone
Sam, �SAffi:GAf�
Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: Single Family Detacifed ❑ 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 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 ()
In S-I•i %1 iA- dam.
vfi
cv: Ge- r-0N%, r' ;/L 0o.o1C
*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 Name: 1 G 1 v' f t' L Signature Date 1- 2 l�