HomeMy WebLinkAbout613 Brewer Dr - Applications/Mechanical - 03/25/2013/1,.,rt Collins
of I
Planning, Development & Transportation
281 N. College Ave P.D. Box 580 .
Fort Colllns, 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 ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation El Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application # 13 o L��0
For office use only 4"
Incomplete applications will not be accepted.
Date & LZ2.c 1� 3-c S
Job Site Address (requlred)
Value of Construction ( bor, inaterials, profit)
Property Owner Name Address
014%1 a� 61
City/State Zip Phone
Applicant Name Address
Gty/State Zip Phone
Z09 U9MCLUA4
FIC10A&14552-
Contractor Address
FGt� � 70S Coma e.
City/State Zip Phone
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Saleytaxn rtsr�—y ail mno-acmrs.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: 'Single 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 XNo if yes, you mayneed to contact Hrstotfc Preservation
If this Is for a demolition permit, what year was the building constructed?
Ifprior to 5975, 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.
suhcantractors I Llst Me company name or aty of Ft Collins //tense ,#
Flectriti ( Plumber MechanlplfIW—q 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 constructlon, t know that a
permit is not valid until it has been paid and issued.
Date [r
no