HomeMy WebLinkAbout4531 Seaboard Ln - Applications/Mechanical - 10/04/2012Oct. 4. 2012 2:10PN1
No.5220 P. i
Cit Of planning, Development & Transportation
FCityof N, College Ave P.O. Box 580
ort Collins 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
4 Demolition (Interior non-structural) Q Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
,0 Fleating Unit ❑ Lawn Sprinkler Q Mobile Home replacement d Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 17 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer), �,r /
Complete all applicable Information on theappllcatl Incomplete applications will not be accepted.
Application # B(aosoi L/P Date
For ofte use only I —1 1 , Q r
Job Site Address (required)
Value of Construction (labor, materials, pront)
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U5l02.
Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
Clty/State Zip
Phone
Contractor Address
Clty/State ZIP
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
'Wes tax numbwIsmquiredbyall mntractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? kkesidential ❑ Commercial
If residential, Is It: 17 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commerdal, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 173 Yes d No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Afpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work I 0J_X_ de I I CG
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Coll/ns llrense 0
MechaNcal Irha 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 hereln 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 1
Print Name: &, Y1A— ' Signature Date