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HomeMy WebLinkAbout5132 Trappers Creek Ct - Applications/Mechanical - 07/16/2012JUL=16-2012 08:26 From:Rllen Service 970 4e4 4448 To:92246134 Paee:3,3 City of Fort Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 60524 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)- Air Conditioning `❑ Demolition (interior non-structuraq ❑ Electrical Alteration (not service change) ❑ Gas Light Gas Log X7� Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing O Sewer Line .. ❑ Photo -voltaic 0 Ventilation p hater Heater ❑ Water Line ❑ WoodrPellet Stove (must be EPA certified, provide make, model a d manufacturer). Complete all applicableeyinformation on the application. Incomplete applications will not be accepted. Application # Date —��~�� o6-y0 For office use only Job Site Address frerrrriredt .513 ;2 -r 19AA199<. Property owner Namp Address RANG e 057D _I Applicant Name Address 401(1 k G1 IA (, �t Value of Construction (talwr, materials, profit) rG CQ �05�8 &60oD City/State Zio Phone City/State Zip Phone , 6aA h s/ cO go 5 2-* j-V- 4914 l Con{t+ractorC ^ A[d�dress��� city/State ZIP A Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Sales tax rwmbw is required by al/ contractors, Are you paying with your trust account? g Yes I(M In Phone Is this a residential or ommerdal project? esldential ❑ Commercial If residential, Is it: mgle. Family Detadted ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multlfamity (apartment) ID Garage ' If commercial, is it: 0 Bank Q Bar 0 Church Q Hotel/Motel ❑ Medical office • ❑ Office ❑ Retail © Restaurant Cl Other (exf taln} Is this building So years of age or more? El ,� Vo t/yes, ynuaWneed to cnnlact'historicPreservahon if this is for a demolition permit, what year was the Ilding constructed? If pnbr to 1975, you will ne%an asbestos assesantent to submit with this application. Description of work _ *If lawn sprinkler/backflow preventer, must list licensed plumber. if flrst-tlme A/c, must list licensed electrician. Subcontractors: L& the company name or City ofRCollins license 0 Electrician Ikumber Mechanical Hoofer other * Report ❑ No 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: \�1h,Qf �i r�'I (�zA4E Print Name: `✓ Signatur Date