HomeMy WebLinkAbout6102 Constellation Dr - Applications/Mechanical - 06/20/2013CityOf Planning, Development & Transportation
C� rrrr►►►►281 N. College Ave P.O. Box 580
�t Collins 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-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 # 6130-305-$ Date
For office use only
Job Site A�d(drress (required)
Value of Construction I bor, materials, profit)
eg�le
/
Property Owner Name Address
2�liz4a' 4A(gr la W6v
City/State
Zip
Phone
Applicant Name Address
7` /v�D
City/State
4o Vzf Ae
Zip
w
Phone
Contactor � � � Address
City/State j
Zip
Phone
".
C/�/ Dr Ofu S S
/- _4m
CJr
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here Report
Sales tax number isrequlredbyall contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? )NResidential ❑ 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 Po If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? 94
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work lezG e � X u rr2ezr
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& ffie company name or City of Ft Collins license #
Bectridan l 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• 1/ /'kf Signature
Date d��