HomeMy WebLinkAbout519 Spin Drift Dr - Applications/Gas - Log, Line, Pipe - 08/29/2018F6City Of Planning, Development & Transportation
rt Collins 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).' Air
Demolition (interior non-structural) Electrical Alteration (not service thane Wing
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing 9) Gas Lighter Gas Log
Ventilation Water Heater Water Line Sewer Line Photo -
manufacturer). Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # $ 1 tD ISlifo
Forofce use only Date
Job Site Address (required)
Property Owner Name ' . Address V
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Applicant Name Address
materials, profit)
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City/State Zip Phone
City/State Zip Phone
Value of
Contractor Address
City/State Zip
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Contractor City of Ft. Collins Sales Tax #
Sa/estaxnumber is Are you paying taxes here or by report?
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required by all
cmtracfors. `T I Are you paying with your trust account?
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Is this a residential or corn
If residential, is it: (51
Commercial
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Phone
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Yes o
Multi amily apa ment) Gara e V e (single family attached) Duplex
If commercial, is it: Bank Bar Church g
Hotel/Motel Medical office Office Retail
Restaurant Other (explain)__
Ithis building So years of age or more? Yes 6
Iff this is for a demolition per ; If yes, you may need to Contact Historic Preservation
mit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this app/ication.
Description of work
I N j
`If lawn sprinkler/dacknow preventer, must list licensed plumber.) If firs -t me A/C, must list tlicensed electrician.
Subcontractors: List the company name or City of Ft Collinslicense0
Electricia 1
Plumber Mechanical
--,___-__ Roofer____ Other
I hereby acknowledge that I have read this application and state that the above information is complete -and . correct. 1 agree to
comply with all requirements contained"herein and city ordinances and state laws regulating building constru
permit is not valid until it has been paid and issued. ction. I know that a
Applicant: �} -
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Print Name: n a�� t� �%
-- r-- Signature L_ -�lC. TlL(-� Date `l ��!//_0