HomeMy WebLinkAbout2300 W Stuart St - Applications/Plumbing - 06/27/2018City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins CO 80524 Main 970 416 2740 Fax 970 224 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing V 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 # ��dS (� Date 271A-' 467
For o>tice use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address ''City/State Zip Phone
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At nt Na e Address �j,City/State / Zip yPhone
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Cof tractor Address City/State Zip Phone
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Contractor City of Ft Collins Sales Tax # Are you$aymg taxes here or by report? ❑ Here ❑ Report
Sales tax number Is required by all contractors Are you,paying with your trust account? ❑ Yes ❑ No
Is this a residential or corcial project? Residential ❑ Commercial
If residential, is it IaSmgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel '3 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this budding 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
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Description of work
*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 # If
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 ( Signature1; /� 4&lw Date 2� 7 k
Revision date 2/6/2017