HomeMy WebLinkAbout2619 Raintree Dr - Applications/Mechanical - 01/16/2013Fort 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 0 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). F�
Complete all applicable information on the application. Incomplete applications will not be accepted. 54. � J
Application # 16ki: % Date i 1 - 7-,>
For office use only
3ob Site Address (requir Valu of Construction labor, materials, profit)
Property Owner Name
Address
City/State Zip Ph
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Applicant N me
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Address
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City/State 1Zip 80S'3-Thone'3a8
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Contractor AOLic #
Address
City/State Zip e0(9�3k-� Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? E144e1e - ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 2,01kesidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
la'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 prior to 1975, you will need an asbestos assessment to submit with this application.
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 or City of Ft Collins license #
Electrician Plumber Mechanica]Vk Al 69 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: l p
Print Name: �-" cZA Signature Date l l
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