HomeMy WebLinkAbout424 WEST ST - APPLICATIONS - 12/5/2017.=at�-05-'17 13:59 FROM- Mr Rooter Plumbing 303-772-4499 T-813 P0001/0001 F-550
Cit of Planning, Development, & Transportation Services
t COUIn$ Community Development & Neighborhood Services
Ile 281 North College Avenue
Fort Collins, CO 80524 Main, 970 416.2740 Fax, 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit O Lawn Sprinkler O Mobile Home replacement ❑ hoofing ❑ 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 applications will not be accepted.
Application # i1 o�`ola l Dam
For ofte Less only
Job Site Address ilregwred) Value of Co I
struction (labor, materials, profit)
142 LiWts S+- • C0 ly)SCG 90521 I clu 1 00
Property Owner Name Address City/State Zip Phone
ct 2 ' • '5 CC �5 �o n Zy`t
Applicant Name Address City/State Zip Phone
6 !(ow PKimij fxeddenck,ca9'051 to ,
Contractor Address City/ tate Zip Phone
Mr 26oke Plumunq 3361 G dcl u 30
Contractor City of R. Collins Sales ax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax numberIsrequi+edbyall contracm x Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or oommerdai protect? V Residential ❑ Commercial
If residential, is it: 19 Single Family Detached O Condo/townhome (single family attached) ❑ Duplex
C] Multifamily (apartment) 0 Garage
If commercial, is it: E3 Bank O Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (explain)
Is this building So years of age or more? O Yes lil( No If yes, you may need to contact NistorIc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 12�LAi�m !I pal 9(A (A)rxtVf q �C wl.ln r1P.i )
*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
lofFt Collins license 0
Electrician Plumber MP %4ta 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 regulatlng building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: t / _
Print Name: iC.fiY1Gt 17.i, Mi.ld.l�tY1 Signature _ Date
Re"Son ante ?i6i2oil