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HomeMy WebLinkAbout1426 W Mountain Ave - Applications/Mechanical - 07/11/2013Jul•18. 2013 2:33PM 9704844448 ALLEN PLUMBING&HTG No•4252 P. 2/8 City of Planning, Development & Transportation 6rt COttins FFo8r1t ColiinseCCOA 0na 'o. e 1 sao .r Phone 97D-416-2740 Fax 224-6134 OVER-THE-COUNTER PER ITS ONLY This application is to be used to apply for the following permits only (check all that apply). Air Conditioning ❑ Demolition (interior non-structural) p Electrical Alteration (not service change) ❑Gas Light e Xc Gas Log seating Unit ❑ Lawn Sprinkler O Mobile Home replacement CIRoofing ❑ bower Line ❑ photo -voltaic O Ventilation 0 Vale, Heater 0 Water Line 0 WOod/Peflet Stove (must be EPA certified, provide make, model and manufacturer), Complete all applicable information on the application. Incomplete applicatio ins will not be accepted. Application # (5lV 3s Date 'Lio- &_1 i For office use only Job Site Address freouired) Owner t Name s. Address Value of Construction (labor, materials, profit) ON/State Zb Phone EE Zip Phone Contractor Address city/state Zip Phone /' , I r Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? O Here Report t Saes tax num, bar Js'regrur2d by al/ contractors. Are You paying with your trust account?X Yes ❑ No Is this a residential or Spmmerdal project% ' !'4entia1 ❑ Commercial If residential, is' Single Family De hed 0 tondo/townhome (single family attached) Q Duplex tj Multifamily (apartment) D Garage r If commercial, is it: © Bank 13 Bar ❑ Church C] Hotel/Motel ❑ Medical office - ❑ Office ❑ Retail O Restaurant. 13 Other (ex lain) Is this building 50 years of age or morel 0Yes '40 If yes, tou /my need to Contact Histork Preservation If this is for a demolition permit, what year was the siding c'snstructed? If prior to 1973; you will nPp.>yan asbestos assessment to sub with tr # apprcation. .0nj, ,Nrmrcier/backtiow preventer, must list licensed plumber, If trst-time A/c, must list licensed electrician. 5ubcontractors: List the company name or Gty of Collins license p Electrician Plumber Mechanical P=fer 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. 1 know that a permit is not valid until it has been paid and issued. Applicant: J/r/�^ Prins Name: �r! �` (�n Signatur _ Date ILL '�