HomeMy WebLinkAbout508 Crestmore Pl - Applications/Mechanical - 10/15/201210/15/2012 MON 10:47 FAX
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FCiof
lirt Colons
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply) XAir 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 KWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the applicatio Incomplete applications will not be accepted.
A lication # 0 !'in''`) U (�o Date
PP For office use.only .I-i� _ -1-A
Sob Site Address (required)
Value, of Construction (labor, materials, profit)
�� Qwner(Vame
Address City/State
Zip
Phone
;&049
ANZ7e
Address City/State
I 64g(1U51'o A00stC1610,
Zip
Phone
3 3.1a-41 0
ntractor
Address City/Sta�g
Zip
Phone
00)�w 41,6r2ti
//go�W &Doffilge,'d
96DR0
303�( #21)9
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or
by report?
Here ❑ Report
sales Wxnumber &requlredbyallwnr,actors. Are you paying with your trust account? ❑ Yes ANo
Is this a residential or commercial project? )KC Residential ❑ Commercial
If residential, is it: $,Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotei/Motel . ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes []No Ifyes, you may need to contact Historic Preservatfon
If this is for a demolition permit; what year was the building constructed?
Ifprfor to 1975, you will need an asbestos assessment to submit w/tfi this. application.
NTI
. i
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List the c»mpany name or City of Ft Collins license #
ElectricianR4F/12&V--- 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: !�F ��
Print Name: /�! .�[ �/D� Signature a A Date lv�