HomeMy WebLinkAbout400 S Grant Ave - Applications/Plumbing - 03/16/2020Fort Collins
Community Development and Neighborhood Services
281 N College buildingservices@fcgov.com
Fort Collins, CO 80524 970-416-2740
Job Site Address
Application # g-0Z D Z I
Date Received S / l6 /�-
Address City/State/ZipOr�T Gau�/l�S'� Ssl1�a J
Property Owner Information
Name
/'G N(�4�U it)OO��GHE j� Phone Number a
Address �f00 S. 6t"kff 9A/E City/State/Zip ymet G,ou .l us ,SS A)
00 Single Family Detached Q Townhome (attached) Q Duplex QApartmentlCondo O Garage/Other
® • Q Bank Q Bar Q Church Q Hotel/Motel O Medical Office Q Office O Retail Q Restaurant
Value of Work
Labor and Materials $ 5�o
Scope of Work
Q Sewer line replacement / new
0 Water line replacement / new
R,Gas line replacement / new
Q Other plumbing work
Feet to be replaced / installed
Feet to be replaced / installed
Feet to be replaced / installedfi ! q
1
Additional Information C7j t-r > Li i� �6 iUl� o u--id60I R PL�4G�
(if applicable)
Plumbing Contractor or Excavation Company
Name PFMI GK- -PLIMA _ K f VU
Address
Phone Number
License Number
Email
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City/State/Zip
M ir-E -H UTSz L 3/1O/Ao2-C
Print Name Signature Date