HomeMy WebLinkAbout1401 Ivy St - Applications/Other - 06/08/2020w
Community Development and Neighborhood Services
281 N College buildingservices@fcgov.com
Fort Collins, CO 80524 970-416-2740
Job Site Address
Address` //-/G
Application # �2 G s, Sd d
Date Received 66L/Z07�
City/State/Zip Fa.(4 6'o&f
Property Owner Information
Name PCoier`, 4, , L-S Phone Number 0170 -2!`j-�0973
Address_ /'/0/ Tuv City/State/Zip
Single Family Detached Q Townhome (attached) Q Duplex QApartment/Condo O Garage/Other
Q Bank Q Bar O Church O Hotel/Motel O Medical Office Q Office O Retail O Restaurant
Value of Work 45;�;—O v
Labor and Materials $
Scope of Work
Wood/Pellet stove (required to be EPA approved) Model Name WCo� CC,
(YF- LI Z " 0300
Manufacturer
O Gas Fireplace Length of extensions of gas line (if necessary)
Please list plumber if not completing
O Fire Pit
Additional Information
(if applicable)
Contractor IJ
Name 46;41 el3c �jn 2 s
Address City/State/Zip
I
Phone Number Email
License Number
Certificate Number
Subcontractor License (if applicable) Subcontractor Name (if applicable)
Print Name Signature Date