HomeMy WebLinkAbout2615 Eagle Roost Pl - Applications/Plumbing - 05/10/2019City of Planning, Development, & Transportation Services
Fart Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 970.416.2740
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 IXGas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ 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 # 7) lq (1, ��)IIv Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
2615 Eagle Roost Dr. Fort Collins, CO 80528 $1800.00
Property Owner Name Address City/State Zip Phone
Phillip Glasgow 2615 Eagle Roost Dr. Fort Collins, CO 80528 970-219-8214
Applicant Name Address City/State Zip Phone
Daniel Ormesher
Contractor Address City/State Zip Phone
Independent Plumbing Solutions, Inc. 1611 E Lincoln Ave, Unit A, FC, CO 80524 970-566-1377
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by allmntractom Are you paying with your trust account? ❑ Yes ❑ No
45189
Is this a residential or commercial project? I$ Residential ❑ Commercial
If residential, is it: iX Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muldfamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes CXNo Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Install approximately 100' of 1" underground PE gas piping from existing meter to
firepit
*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 #
Electrician Plumber MPS10 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: -$-- 7
Print Name: Daniel Ormesher Signature r Date
Revised 11232016