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HomeMy WebLinkAbout6703 Antigua Dr - Applications/Mechanical - 07/11/2013Jul,18. 2013 2:33PM 9704844448 ALLEN PLUMBING&HTG No•4252 P. 3/8 City of Tort Colons Planning, Development &'Transportation 281 N. College'Ave P.O. Box 580 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 O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) O Gas Light ❑ Gas Log eating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ $ewer Line ❑ Photo -voltaic ❑ Ventilation 0 Nater Heater O Water Line 0 WoodlPellet Stove (must be EPA certified, provide make, model and manufacturer) Complete all applliicca.ble information on the application. incomplete applications will not be accepted. Application # 1.J1 Date '7 1/-/3 For office use orriy Job Site Addre s (recuired) Owner NA (/ Address ' P-TI S Jt ii9l* , foal` Value of Construction (labor, materials, profitl /7 A��� City/State Zio Phone Zip Phone Contractor Address City/state Zip Phone Sun rc 2.. yC"o �. (�,d �, � Lf�►'IS O �05dt _ �S�!- �yi Contractor City or Ft. Collins Sales Tax # Are you paying taxes here or by report? © Here XP,eport i Sales tax numberis required by all mn&=", Are you paying with your trust account?)K Yes ❑ No 1 Is this a residential or commerdal project?❑Commercial If residential, is Yj' Single Family De Condo/townhome (single family attached) © Dupiex Multifamily (apartment) 0 Garage i if commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office • 13 Office © Retail ❑ Restaurant El Other (ex aln) . Is this building 5o years of age or more? O Yes NNO Ifyes, you may acted to =tact Historic Preservation If this Is for a demolition permit, what year was dWihillding constructed? i If prior to 197S, you will nrec�an asbestos assessment to submit with gA app#Cafion. 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: Ij - �112f ri cif t Til(� - Print Name: Signatur Date