HomeMy WebLinkAbout425 W Mountain Ave - Applications/Air Conditioner - 08/01/2013Aug. 1. 2013 9:59AM 9704844448 ALLEN PLUMBING&HTG
No•4365 P. 2/9
4;
City of
Planning, Deveiopment & i ranspor:atior,
281 N. College'Ave P.O. Bo;: 580
Fort Collins, CO 80524
Phone 970-416-2740 Fa:224-613E
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply) Al. Conditionin^
O Demolition (interior non-structural) 13 Electrical Alteration (not service change) ❑ Gas Lighter ,Gas Log
." Qr .wring Unit ❑ Lawn Sprinkler El Mobile Home replacement ❑ Roofing -0 Sewer Line MI Phoia-voltaic
O Ventilation ] Naler Heater 0 lvl'ater Line a Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer),
Complete all applicable information on the app"catior- incomplete applications will not be accepted.
Application # f l _7V" 6 � mate r �—
For office use only `"._A
Job Site Address freauired) Value of COWL-ucdor° (labor, materials, profit)
Sib A,a
Pr rtv Owner Nam Address City/State Zio
Phone
��A e plicant Na Address Ctylstate �n Zip Phone
1� �C e��, C7�+<' t �� �p�. •i - r.� � �/veF'f. '�''G �,/�i, (���� 1
Contractor Address C=y/State ro a
o nn_
l i a^3: r. C. �:
Contractor City of FL Collins Sales Tax Are You payin_ taxes here or by report? �, Mere s^ Fcepo '
Sales to number required bya/1 cvntia:tas 'kre YOU I7ayi1,9 wii h your, trust account,o
Is this a residentiai or Sommerdal project? -� .r ential , ❑ ConTmerctal
If residential, is: i:LSingle Family De ta itl�o ❑ Condolbawnhome (single family atta hell) Z Dupie
P a Muldfamily (apartment) ❑Garage
If commercial, is It. 11 Bank ❑ Bar 0 Church 17 HoteVmotel 17 Medical office • Ej OfiiC:e ❑ Retai!
❑ Restaurant 0Other (ex laln)
Is this building 50 years of age or morel ' E3 Yes Na Ifye✓, you may need't7 �nnta� Ni�7oric r'resenia[ron
If this is for a demolition permit, what year was the liding constructed?
If prior to 197S, you will nf�efan asbestos assessment to submt- with tl # appAcadon,
Description of yrprka
none e4rsf1ri� nNFOn�rr
owit npnnKler/backPioyv oreventer. MW list L-MARd rill imlwr. IF kn
Subcontractors: List the company name or City of Col/ins license d'
nws, !L L .;
Electrician Plumber Mecharimad . Roofer
anc�
Other
t nereoy acknowledge that I have read this application and state that the above information Is camolete and Corra=,. ? agree to
comply with all requlr_ements contained herein and d'trr-ordinar!c�, and state taws regulating building ;rnstn;ct:or:, i nay. ;n�; a
permit "smut valid untfl it has $e-eii paid ant, i=sued,
Applicant: �l��.trrd`! ' tr� - t
Print Name: Signatur �a:� - 3