HomeMy WebLinkAbout3760 Kentford Rd - Applications/Mechanical - 08/01/2012Fort Collins
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 8OS24
Phone 970-416-274o 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). it Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 13 Gas Log
Ideating Unit ❑ Lawn Sprinkler O 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 information on the application. Incomplete applications will not be accepted.
12, Application # L2 I OZ� 1 %��
For ofte use only
Date 15MV.-I
lob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip - Phone
Applicant Name Address Gty/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ® Report
.s3/5 tar nomberIsrei4&'redbyall mnbaCWrs Are you paying with your trust account? XYes 13 No
Is this a residential or commercial project? Wesidential ❑ Commercial
If residential; is it: QpIngle Family Detached ❑ Condo/townhome (single family attached) . ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant O Other (explain)
is this building 50 years of age or more? O Yes ❑ No If yM you may need to contact HLstoric Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you w111 need an asbestos assessment to submit w/th fts application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; List the company name or Gty offt Collins license 0
Elecirioan . Plumber 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: \�CD� _ 17r,�Q)ryn Signature., A Q kNk— Date
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