HomeMy WebLinkAbout2301 Coventry Ct - Applications/Mechanical - 10/02/2012Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
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-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 information on the application. Incomplete applications will not be accepted.
Application # / Date 6CK 2 - SOU
For o r _ush only
Job Site Address (required) Value of Construction (labor, materials, profit)
cr-
301 OCR
Property Owner Name
Address
City/State
Zip
Phone
`a."? /-9,'E rc t '/os-
.EM ,Si
A s
�05 /
y53 a y6
Applicant Name
Address
City/State
Zip
Phone
13/2.:9^,' 2OL
^Kf 44' /=- e'-"1,- s
8452
'>Oc/
Contractor Lic #
Address
City/State
Zip
Phone
S I4 11 / O/
G /`LESS/-►n�
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 1-Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes 19 No
Is this a residential or commercial project? XrResidential ❑ Commercial
If residential, is it: d!�Single 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 SO years of age or more? ❑ Yes cMNo 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 w/th this applicadon.
Description of work
dn/ .
*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:
Print Name:/C � A;5'At rJi'�/=�cs//Signature_ J.• ���� .-�i Date