HomeMy WebLinkAbout417 S Grant Ave - Applications/Gas - Log, Line, Pipe - 01/30/2012Jan 30 12 11:19a FyrePro Inc.
970-282-0885 p.1
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort CottinS _ 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). ❑ r Conditionir), g
❑ Demolition (interior non-structural) D Electrical Alteration (not service change) ❑ Gas Lighter )Gas Log la"
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne 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 applic tions will not be accepted.
Application #� , Date
For office use oniy
Job Site A
re (required)
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Value of Construction (labor, materials, profit)
Pro Owner Nam
Address tate
Zip
Phone
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232-52q
licant N e
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Address City/ ale
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Zip
Phone
q _-70 a 13 -79 401
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here Pc8eport
salestax number isrequired byall conr'actors
Are you paying with your trust account?
❑ Yes 1"CDlo
Is this a residential or commercial project? '4esidential ❑ Commercial
If residential, is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
43 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? ❑ Yes rz!rAlo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ypaor to 1975, you will need an asbestos assessment to submit with this application.
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*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
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:
Pri&k. lztyicl as
nt Name: Signature Date