HomeMy WebLinkAbout4320 Gemstone Ct - Applications/Mechanical - 08/04/2011AUG-16-2011 14:02 From:Allen Service
City of
ort Collins
970 484 4448 To:92246134 Pase:3,5
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVE -THE-COUNTER PERMITS ONLY
This application is,ta be used to apply for the following permits only (check all that apply). j4ir Conditioning
❑ Demolition (interior non-struc ural) ❑ Electrical Alteration (not service change) O Gas Light ❑ Gas Log
Heating Unit ❑ Lawn Sprin ler ❑ Mobile Home replacement ❑ Roofing p Sewer Line ❑ Photo -voltaic
ell ❑ Ventilation ❑ Water Heater 0 Water Line ❑ Wood/Pellet Stove (rrust be EPA certified, provide make, model and
manufacturer)_
Complete all applicable inforr iation on the application. Incomplete applications
''will not be accepted.
Application #. Date
For offrte wee on i�
Job Site Address (required)
Value of Construction (labor, materials, profit)
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FC L D lyo.sa ' o-; goo
Property Owner Name Address City/State Zip Phone
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Applicant Name
Address City/State Zip Phone
Contractor
Address City/State Zp Phone
Aoi—st 4bW W .o O 4oz4 48L/- 78
Tax # Are you paying taxes here or by report? ❑ Here XReport
Contractor City of Ft. Collins Sales
sore; lay number is required byaNconopcwrs
o
Are you paying with your trust account? )KYes ❑ No
Is this a residential or commercial
project? )<Resid ndal ❑ Commercial
If residential, is it: ❑ Single Fa
ily Detached Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily
(apartment) ❑ Garage r
If commercial, is it: O Bank ❑
Bar ❑ Church O Hotel/Motel ❑ Medical office ❑ Office O Retail
❑ Restaurant
0 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 I975, you will need an
sbest os assessment to submit with this application.
Description of work &Wn
*If lawn sprinkler/backnow preventer,
must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the compan
name or City of Collins license #
Electrician — PIum6
Merhanical 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 hash been
paid and issued.
Applicant:
Print Name:
Signatur Date v .