HomeMy WebLinkAbout612 Castle Ridge Ct - Applications/Gas - Log, Line, Pipe - 01/17/2017Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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). Aing
ir
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter !""Gas Lo
-fond" nllllll
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line
Ventilation Water Heater Water Line. Photo=crothafc—
manufacturer). Wood/Pell Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # For '
e�LA Date pz_� U R2� U l'�,
Sob Site Address (required)
Property Owner Name Address
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Applicant Name Address
'Rriii—r-i Clty/State Zip
Value of Construction (labor, materials, profit)
City/State Zip
Contractor
Address Clty/State
W L T1712I4 i✓ ltzFt 1 �C{ �i P �U Zip
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Contractor city of Ft. Collins Sales Tax #
Salestarnrmlerls Are you paying taxes here or by report?
repuiredbyallmnb-actory Are you paying with our trust account?
1U Y
Is this a residential or
It residential, is it:
Commercial
nho
Phone
Phone
4%.`A
Here ort
Yes o
Multi ia ly(ap rt-men ' • me (single family attached) Duplex
if commercial, is it: Bank Bar Church Hotel/Motel medical office Office Retail
Restaurant Other (explain)
If 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?
Ifpnor to 1975, you wit/ need an asbestos assessment to submit with this application.
of
`[f fawn sprinklzr/backflow preventer, must list licensed plumber. If fr;t•tinie AiC, must list licensed electrician.
El
Subcontractors; List the company name or City of Ft Collins license at ectrician •-
----,� Plumber
--�_ Mechanical`_ Roofer
Other
1 tlerP.11y
- � sport rcao cnls 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:' t/
Signature
Date I (-:�