HomeMy WebLinkAbout5412 Fossil Ct N - Applications/Mechanical - 10/05/2011OCT-06-2011 08:53 From:Allen Service 970 484 444e To:92246134 Paee:7/9
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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 -strut ural) O Electrical Alteration (not service change) ❑ Gas Light ce�r A Gas Log
veating Unit ❑ Lawn Sprinkler El Mobile Home replacement ❑ Roofing ❑ Sewer Line. ❑ Photo -voltaic
entilation ❑ Water Heater P Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). I
Complete all applicable information on the application.
Application # g� `
For ogee use on
Incomplete applications will not be accepted.
Date /4- 5-//
Job Site Address (r ;
,5411A ass 7ur o
Value of Construction (labor, materials, profit)
P& aq go 5a6' ,
Property Owner Name i Address
City/State Zip Phone
5
Applicant Name Address
City/State Zip Phone
Contractor Address
Gty/State Zip Phone
�a�G
Contractor City of Ft. Collins Sal s Tax #
sales tax number is wouired by all can ctors
r► Qos� `�8`I- �{S
Are you paying taxes here or by report? ❑ Here Report
Are you paying with your trust account? g Yes ❑ No
Is this a residential or commercial project? esidendal ❑ Commercial
If residential, is it: ❑Single Fa ily Detachondo/townhome (single family attached) ❑Duplex
❑ Multlfami (apartment) 0 Garage +
If commercial, is It; ❑ Bank ❑ Bar O Church O Hotel/Motel ❑ Medical office ❑ Office El Retail
❑ Restaura t ❑ Other (explain)
Is this building Sq years of age or more? ❑ Yes O No if yes, yvu mayneed to confacrHisto&Preservation
If this Is for a demolition permi , what year was the building constructed?
If prior to .f 97S, you will need an osbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backnow
Subcontractors; List the
Electrician
I hereby acknowledge that I have
comply with all requirements cont
permit is not valid until it has
Applicant:
Print Name:
r, must list licensed plumber. If first-time A/C, must list licensed electrkian.
name or C11y of Ft Collins license 0
Mechanical Roofer
Other
this application and state that the above information is complete and correct. I agree to
herein and city ordinances and state laws regulating building construction. I know that a
paid and issued.
�� Signatur Date T� !