HomeMy WebLinkAbout1942 Leicester Way - Applications/Gas - Log, Line, Pipe - 06/11/2019Phone
Phone
Here a ort
Yes No
Duplex
rwmramuy (apartme-M 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 Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of work
rlr. r;,e mQ Yl . wire i �h ur
*If lawn sprinkler/backFlow preventer,
Cityof Planning, Development & Transportation `v
281 N. College Ave P.O. Box 580
Fort Collins IS 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 Wing
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter Gas Log
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
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
2
Application # ) I l ( � 0'�, _ Date �' �i `O�
For ofce use only
Job Site Address (required)
10//a Le/C e5ell
Property Owner Name
ApplicanfName
Value of Construction (labor materials, profit)
r_ (�, • ?o 6c;?6 & / ID
Address City/State Zip pho7D
e b,eiefetd jq14Q fT lA�t/Jr F�� �in���o Ll i5
Contractory
W -`)T4 lE .t lc -
Address City/State Zip
r
Address City/State Zip
Contractor City of Ft. Collins Sales Tax # /
Sa/es tax number is required by all contractors G_
Is this a residential or co
If residential, is it: Single Family
Are you paying taxes here or by report?
Are you paying with your trust account?
Commercial
nhome (single family attached)
-lF? i�L��y2f f/?l�fixis
r
list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or city of Ft Collins license #
SectricianPY0 I -fC+n C�- 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: Signature
Date