HomeMy WebLinkAbout5907 Greenridge Cir - Applications/Mechanical - 01/24/2013of
Frt 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).ir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑Gas Lighter ❑ Gas Log
ating 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 #
o00 35S
For office use only
Date `\a�1\' 1—C T
Job Site Address (required)
Value of Construction (labor, materials, profit)
ac,zGil
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
. /State Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
IM Report
Safes taxrnanberismquiredbyancono-actws:
Are you paying with your trust account? XYes
El No
Is this a residential orl mer'al projed7 esidential ❑Commercial
If residential; is it. ngle 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 pr1or to 197S, you will need an asbestos assessment to submit with this applicalion.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name ar Gty ofR Callins license 0
EleRrician`11�Phimber _i�_ 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: S) CLaXt2 l7T\ 0—\XRh Signatures Date
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