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HomeMy WebLinkAbout1121 Juniper Ct - Applications/Water Heater - 05/23/201905/28/2019 22:01 FAX 9703517127 RAMS PLUMBING INC Ia 001 Fort Collins of Planning, Development 8r Transportation 281 N. College Ave P.O. Box 580 Fort Collinsr CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application in 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 M Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line D Photo-voltalc ❑ Ventilaition WMater Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and manutacturer), Complete all applicable information on the application. Incomplete applications will not be accepted. Application #o Date For ofPrce use only Job Site Address (required) Value of Construction (labor, materials, profit) ►121 -Jun i Pt=_ic C&.. 2-I � Ci50 cc Property Owner Name Address City/State Zip Phone 1Mz y' I law OKEW iIZ.I UOniFEEIC C-r. l=T C3L,LiiIS, eb $OSZI 0,70) 219 cl c-i Applicant Name Address city/State ZIP . Phone Contractor Lic # Address Clty/State Zip Phone 9,AM5 PLWmg117,1(3 MP-53y Po C3DX IN9s FT C-OLI.I/\::)i 00 50522 Lo9D-V191 Contractor City of Pt. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Or Report sales tax numberlsrequired byallcori e&m Are you paying with your trust account? *11 Ll233 9 P11' Yes ❑ No Is this a residential or commercial project? W Residential ❑ Commercial If residential, is it: I9 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (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? ElYes ❑ No If yes, you may need to contactHlstodc Prese mo_tion If this Is for a demolition permit, what year was the building constructed? If prior to 1975, you wit/flied an asbestas assessment to submlt wi& this application. Description of work J KI�V,IJ u _ fIweyn 1'� W Mt5"k_ "eaa7(;L�4 *If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors; list the company name or Cgy of Ft Collins license cif Electrician Plumber. Mechanlcal 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: 21'`✓ M Signature „v.„ 1' Date 2