HomeMy WebLinkAbout4249 KINGSBURY DR - APPLICATIONS - 9/14/2018City af Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 970.416.2740
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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home 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 informat' n on the
application. Incomplete applications will not be accepted.
Application # ` 'L
For o se only
Date le] l E
Job Site Address (required) Value of Construction (labor, materials, profit)
4249 Kingsbury Dr 450.00
Property Owner Name Address City/State Zip Phone
Rebecca Gregory - Andrew Hill 4249 Kingsbury Dr Fort Collins, CO 80528 970-217-9298
Applicant Name Address City/State Zip Phone
Daniel Ormesher
Contractor Address City/State Zip Phone
Independent Plumbing Solutions, Inc. 1611 E Lincoln Ave, Unit A, FC, CO 80524 970-566-1377
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
5alestax number 15requiredbyall contractors. Are you paying with your trust account? ❑ Yes ) ✓V0
45189
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: 19 Single Family Detac ed ❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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 [KNo Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Install approx. 10' of gas line from mechanical room to cook top.
*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 MP610 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: Daniel Ormesher Signature Date
Revised 11/23/2016