HomeMy WebLinkAbout4524 Seaway Cir - Applications/Mechanical - 08/05/2011CI of Planning, Development Ili Transportation
Fort CollinsCFort N. College Ave P.O. Box 580
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 ❑ 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).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 5 1 0-�v yI Date 815��1
Air oltice use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
37
Property Owner Name Address
City/State Zip
Phone
LN
owq
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
-
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
50 Report
sales tax number aregt*Wbyall covtral=
Are you paying with your trust account? AYes
13No
Is this a residential o commercial project? tfillesidential ❑ Commercial
If residential, is It: WSingle 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 SO years of age or more? ❑ Yes ❑ No If yes, you inayneed to contact Historic Preservation
If this Is for a demolition.permit, what year was the building constructed?
Ifpr1br to 1975, you W11 need an asbemis assessment to submit with this application.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name or Gty of Collins lrceme �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: VVILLQ�e G%�. Signature Q Date 0 5
1,00/1.00'd 09011 68:90 IIOZ/50/80 £LOZisMS .rty XaiTPA aapn0d:w0ad