HomeMy WebLinkAbout2937 Eastborough Dr - Applications/Mechanical - 03/04/2013Frow Poudre Valley Air 9704932073 03/05/2013 06:40 11085 P.001/001
Fort Collins,
Planning, Development & Transportation
281 N. College'Ave p,O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 ❑ Gas Log
*Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation TiWater 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 # °J ( �bl0
For oASce use only
Date
lob Site Address (requNed)
o-1 FS�P>>c
Value of Construction (labor, materials, profit)
S`
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
14 Report
.sales tax number &requircdbyall con&aam
Are you paying with your trust account? 9Yes
ij No
Is this a residential or commercial project? NP Residential ❑ Commercial
If residential, Is It: Ingle Family Detachdd ❑ 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? 17 Yes O No If yes, you may need to contact Historlcpreservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you willl need an asbestos assessment to submit wide this application. 110. _
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or Qy of fi• Collins Rcense f
Electrician 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:
Print Name:�\VLOX;! - G, . —Signature •. 0.a �Date