HomeMy WebLinkAbout4504 Seaway Cir - Applications/Gas - Log, Line, Pipe - 03/22/2019q0
�Clt ��ollins
FortPlanning, Development & Transportation
OILL For N. College Ave P.O. Box 580
� „ 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 Wing
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter Gas Log
manufacturer).
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -
Ventilation Water Heater Water Line Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable nformati(o1n on theeaappli ation. incomplete applications will not be accepted.
Application # I 1y n J�
Date
For office use only
Job Site Address (required)
gSoLl Seatoaq (21R,
Property Owner Name Address
Applicant Name Address
Value of Construction (labor, materials, profit)
�C. OD
City/State Zip
I'
City/State Zip
Contractor Address City/State Zip
Wt:' 4C 1 -0 �1+�`I Ll`L— Su( eL..V N06 t-1Jr__(./Co 0052L4
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
Sales tax number is required by allmntractom. Are you paying with your trust account?
Phone
7-y9
Phone
Phone
` -9c- 7 C) V=
Here e ort
Yes No
Is this a residential or comm e pni esiden ' Commercial
If residential, is it: Ingle Family Detache Condo/townhome (single family attached) Duplex
Multifamily (apartment) Garage
If commercial, is it: Bank Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explai
Is this building 50 years of age or more? Yes No If yes, you may need to contact Historicpreseruation
If this is for a demolition permit, what year was the ui ding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
ption of work &
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-Ume A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber
Mechanical Roofer Other
-e
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: __r� 5
Print Name: )df Y �� Signature vL 7t �(2(/t Date