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HomeMy WebLinkAbout632 Prichett Ct - Applications/Mechanical - 06/21/201306/21/2013 17:36 9704844373 BALANCE POINT PAGE 01 biit Planning, Development &Transportation FFY 281 N. College Ave P.O. Box 530 ort CoRins Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply forthe following permits only (check all that apply). ❑ Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log Q Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic 0 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information oonthe application. Incomplete applications will not be accepted. Application # 1�1/Gieabate _ ��o1 13 .c_?2 Fo7 atirce use only Job site Address (required) PR ICHC-rr -._.. value f Construction (labor, materials, profit) ( l' Co„c- y21--oAI ns I /�I C'--:2-9 , o o Property Owner Name Address City/State 7_Ip qr�b_ hone �Iq--t�bb G_��.�oc-�ac� Cv3� P�;-�-c4e� C�,�.c�-, �-T�c�►iz�,�, c_o �.�.3.� Applicant Name Address City/State Zip Phon ..->��:�+.�` "�'�.,�i1�ie�t-1,�,• �t- (-�;� C,���,� �a-,,.��, =3 i {: Cc �ti,m�•c� Z� , v� C"r. c� I t�,�<3 c., .� Contractor Address City/State Zip Phone . ;'�.' f, i �y� i� tiir �u,,♦✓.h'��,: i 11._ r: 0 5"L` ��� l ��� ,: !' a i �� t CCC�•� ,�lr� ic,��rt Contractor City of Ft, Collins Sales TaX # Are you paying taxes here or by report? ❑ Here deport Solos tax number, lsrequired byall contractors. Are you paying with your trust account?XYeS ❑ No Is this a residential or commercial project? Residential . ❑ Commercial If residential, Is It: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex Cl Multifamily (apartment) ❑ Garage If eommerriai, is It: © Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? CI Yes ❑ No ffyes, you may need to contact Historic!'reseivadon If this is for a demolition permit, what year was the building constructed? If prror d r 1975, ynu will need an asbestos assessment to submit With mis application. Description of work *If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan. Subcontractors: List the company name or City of Ft Collins license � Eleu.rician-,,,,,_,- 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 requirement 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. Print Name. �1 Signature -pate �0