HomeMy WebLinkAbout1330 Iva Ct - Applications/Mechanical - 10/23/2012City Of Planning, Development & Transportation
y} 281 N. College Ave P.O. Box 580
` Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 ���'qK
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 appli ab�lefi�nf/or2matioon on the application. Incomplete applicationswillnot be accepted.
Application # �d'l/19�7� 1 Date /0 -dZam `Id -
For office use only
Job Site Address (required) Value of Conduction (labor, materials, profit)
/ 33b �v� C�iEi 10
Prope gwner Name
Address / O r-C , City/State fe-J Zip $'9•56)5
Phone /0
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Applicant Name
Add ess 31'09 r- City/State Zip e' S•a X Phone "o
wlb"717 30 Cooly %�
C tractor
Lic # f_a0eT,&ddress City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?Here
Report
Sales tax number is required byall contractors . Are you paying with your trust account? es
❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: aMg 1e 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 ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes []No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of
*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 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 /rj/�j/r5 /'/�
Print Name: lye e / Signatu Date