HomeMy WebLinkAbout841 BALSAM LN - PERMITS - 6/30/2021City of
,ktColli~
Site Address: 841 BALSAM LN
Job Valuation: $1,968.07 Category: Residential
Owner: PIXLER WAYDENE L
841 BALSAM LN
FORT COLLINS, CO 80526-1901
Zoning: Front setback: Rear setback:
Community Development & Neighborhood Services
281 N. College Ave Fort Collins, CO 80522
970.221.6760 970.224 .6134 -fax
Building Permit#: B2105128
Issued Full: 06/30/2021
Permit Type: Residential Plumbing
Phone: 970-631-1917
Right setback: Left setback: -----Minor Amend#: ______ P lat File#: _____ ZBA Case #:
Zoning district RL -LOW DENSIT Y RESIDENTIAL DISTRICT
Legal: Subdivision/PUD Filing#: ----------------Lot#: Block#:
Code: Res sq ft: ____ Com sq ft
# of stories: ____ 0cc Group:
Ind sq ft:
Const Type:
Basement sq ft: --------
Fire Sprklr: ____ Stock pla n #: ___ _ ---------------------Stock plan options: ------------------Contractor: ELITE ROOTER DENVER
609 Technology Circle, Suite C
Windsor, CO 80550
License#: ROW-2100007 Supervisor ce rt#:
Subcontractor(s)
Work Description: Replace 34' of sewer line w/ 4" clean outs
Phone 503-593-5853
Phone License Number
SCHEDULE INSPECTIONS: ** via Text Message: 888-406-6394 ** By Phone: 970-221-6769
** Online Portal: fcgov.com/CitizenAccess ** Online Porta l via Mobile Device: fcgov.com/CitizenAccess/mobile
Possible Inspections Required 200 204 102 301 302 300
TOTAL FEES PAID AS OF 06/30/21: $110.76
•• Fee Detail Displayed on Next Page
Payment method: Credit Card 9311
As a condition for the issuance of a permit, I hereby declare that I am the owner or owner's agent, authorized to perform the proposed work on the property described herein .
I agree to comply with all the requirements contained herein, and City ordinances . and State laws associated with such work. I understand that such permit may be
revoked in the event that issuance was based on incorrect information. This permit shall become null and void if the work authorized by su ch permit is not commenced,
suspended, abandoned or not inspected within 180 days from the date of such permit
Carbon Monoxide Alarm required within 15 feet of each bedroom entrance.
Signature: Print Name: Date: -------------------------------------
Form Revised Oct 2010
City of
,ktColli~
Site Address: 841 BALSAM LN
Job Valuation: $1 ,96 8 .07 Category : Resid ential
Transactions
Method
Cred it Card
Check Number
CK#931 1
Date Paid
06/30/2021
Receipt issued: 06/30/2021 Total Paid to Date:
Fee Description
Cit y Sales/Use Tax
County Sales/Use Ta x
Permit Flat Fee -$65
Account Code
25 1.122030
100.217030
1000.422010
TOTAL FEES:
Amount Paid
$1 10.76
$1 10.76
Fee Amount
$37.89
$7 .87
$65.00
$110.76
Community Development & Neighborhood Services
281 N . College Ave Fort Collins, CO 80522
970.221.6760 970.224.6134 -Jax
Building Permit#: B2105128
Issued Full: 06/30/2 021
Permit Type: Res i dential P l umbi ng
Comments
Amount Paid
$37 .89
$7.87
$65.00
$110.76
Da te Paid
06/30/2021
06/30/202 1
06/30/2021
Amount D ue
$0 .00
$0.00
$0.00
$0.00
TOT AL BALANCE DUE AS OF 06/30/2021 :
F ee Amounts are valid for d at e o f this docum e nt only. Fe e s subject to c h ang e w ithout notice.
Form Revised Oct 20 10
Cityof
ktCoU~
PLUMBING PERMIT APPLICATION
Community Development and Neighborhood Services
281 N College build ingservices@fcgov.com
Fort Colli ns , CO 80 524 970-416-2740
Application# _________ _
Date Received
ALL information is REQUIRED . Incomplete applications will not be accepted .
Job Site Address 1/,
Address IS' I
Property Owner Information
Name WA'/ D€"/\/{;. PrXLEtf2_
Ad dress 80 L5cJ Is &01 1/,lt:
• 'I!-"••.
City/State/Zip ;;;;l t?u ws O cfo52b
Phone Number -'<(_.......9___.7--'-0.,,LJ--"'-6 --"3 -'-/_-_/ !J~/_7-~-----::;,,.---
C ity/State/Zip h;ef?, {l;lLuJ,f:u} J'o5Zb
:o ·Res,oENTIAL ·
, •· •1 -...
~Single Family Detached O Townhome (attached) 0 Duplex 0 Apartment/Condo O Garage/Other
0 Bank O Bar O Church O Hotel/Motel O Medical Office O Office ORetail 0 Restaurant
Value of Work \ q ~ A (j; : en
Labor and Materials$ ---1-~~--\) _____ _
Scope of Work
~wer line replacement I new
0 Water lin e replacement / new
0 Gas line replacement/ new
0 Other plumbing work
Feet to be replaced I installed St/' -&-Jckttt9t€/) /IJ411tl t../df" wj fl1
/
Additional Information
(if app li cab le)
Feet to be replaced /installed _______ _
Feet to be replaced/ installed _______ _
Plum bing Contractor or Ex cavation Company
C{tl?,J CN/ 7:J -~
?IP£ /31/12.5 T
Name --~e ........... ·{,,,,_/-'-'Jl; _ ___,_g+'()"'"'0"'-~7 -=t:-;_e....-'----------------------
Address ----"6'---"'o---'-9___,,,....'---'--¥'.,__M-=-='tJ-=l =--0 -=-6 _._1/~C '---z6'--cc,.....;.._f-..-,,.......=-5t_tO_'T{Z=, '----c_· -City/State/Zip t<)/NOt,52?£, Ct} oO§o
3Z5-6'-lob Phone Number _ ___,.,_,__,__-,,,<----=--=-"-----='------ii~:!!,.,-,,.;,--------------------
License Number _____________ _
1/1111(,.; c;-.1 ti
I hereby ackn owledge t hat I have read this app lication and state that the above in forma tion 1s comp lete and co rrect. I ag ree to comply
with all requireme nts conta in e d herein and city ordinances and state laws regulating build ing co nstruction. I know that a permit is not
valid until it has been paid and issued .
3/IIJvv M RZ-~~D
Print Na me 9-__?o) 5t./ -oo 7 o Signature
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