HomeMy WebLinkAbout609 JANSEN DR - APPLICATIONS - 11/21/2017 (2)tinsr>�
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PERMITSONLY
This apAllcation is to be used to apply for the following perrrlits only (check all that apply).Air Conditioning
❑ DP ..riition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Llghte Gas Log
F.f mating Unit El Lawn Sprinkler [I Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
e 1il_Ut � q b Date 11 4JI 7_
Pot office use only
Sob Site Address (�2qu/red) value of Construction (labor, materials, profit)
Zip Phone
Property owner Name Address City/State 97� —
lO A
Address City/State Zip Phone
Applicant Namepa %/ qV _rfW yeg/
Nand o�cn lip,
E' '7 7o i� 7
Contractor
Address City/State Zip Phone
p
Are you paying taxes here or by report? ❑ Here' Report
Contractor AA -City of Ft. Collins Sales'Tax # Are ou paying with your trust account? JYes ❑ No
:ales tat number is required by all contractors
/DID
Planningr Development & Transportation
281 N. College Ave P.O. Bax 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
Is this a residential or cc nhercial project? 'residential L7 Commercial
if residential, is it: le Family Detached ❑ Condo/townhome (single family attached) El Duplex
❑ Multifamily (apartment) ❑ Garage
it commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building So years of age or more? a Yes E3No IfYas YourriaYneed ro COR��H/ Once ��on
If pd is fora 5,demolition
yoLl1',w % n permit, sbestowhat year
a rwas the ssessnent toisubrnitt rMfh � app/icadon.
ing constructed?
Sf pilot to 1975, yo
Description of work
i
'�'rr lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electnclan.
Subcontractors: List the con panynama orcity offtCollins license #
Other
Plumber Raorer.
Mechanical
i f hemby acknowledge that I have read this application and state that the above information is complete and correct I agree to
conhply with all requirements contained herein and city ordinances and state laws regulating building construction. Y know that a
permit is not valid until it has been paid and issued.
I Applicant: -
I Print Name., �•"G �an_ �'. sr�natvre� �,. � �� t ���__