HomeMy WebLinkAbout2748 Pampas Dr - Applications/Mechanical - 11/26/2012NOU-26-2012 08:34 From:Rllen Service
City of
Fort Collins
970 484 4448 To:92246134 Paae:6�9
Planning, Development & Transportatlon
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 a0 that apply). 0 Air Conditioning
��Q Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Q Gas Log
dealing Unit O Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Una _ O Photo -voltaic
O ventilation 4aler Heater ❑ Water Line ❑ WoodlPeliet Steve (must be EPA ceriifted, provide make, model and
manufacturer
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 43 la 0 j 0 �J1
For aYrce use o*
Date 11-a&-/.1- � I dv
Sob Site Address IremitreD)
�7 �k
Value of Construction (labor, materials, profit)
,
C �o
DSaly
,DD
Pr rtv Owner Namp
Adto Je
Address
eL
b ty�/
Zia Phone
Eegi6� 3og-Ag9--i543
Applicant Name
.Sk0ti (it
Address
Llkv
City/state
P, AAki GG
Zip
905.,74'
Phone
JV,49,4g4l
Contractor
Address
City/state
Tip
Phone
r iV"
a.
TOs-q
4sy- ys 1
Contractor City of Pt. Collins Sales Tax 0
Are you paying taxes here or by report?
0�{ Here Report
Saks tar nwnder a repaired by ail rn+a^arrm
WC) /_ n
Are you paying with your trust account?
)K Yes O No
Is this a residential`or�merdal project? ai esk ential Cl Commerdal
If residential, Is it: T 5ltgle Fatuity DeWdled ❑ C0060/townhome (single family attached) ❑ Duplex
D Multifamily (apartment) ❑ Garage
If commercial, is it: O Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office • ❑ Office O Retail
❑ Restaurant 0 Other (ex In)
Is this building 50 years of age or more? O Yes No If yu7,. you may need to coritact Historic preservation
It this is for a demolition permit, what year was the k0ng constructed?
/f prior ro 1975, yvu wit/ neqo�an asbestos assessment to su&wt wiM this dpp#Cabiwr.
`If lawn sprinklerlbackflow preventer, must list licensed plumber, If first-time qrC, must list licensed electrician.
Subcontractors: List the Company name or t7ty ofFt Collins &cane I
E1CCtrk an Pkxnber
511?1.t
I hereby acknowledge that I have read this application and state that the above Wortnation Is complete and correct. I agree to
comply with all reauirements 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: S�Qtr�l (('IAt1
Print Name: Signal
UrNA
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