HomeMy WebLinkAbout1707 Dora St - Applications/Mechanical - 06/25/201307/12/2010 02:45
#0760 P.001 /001
City of
�F6rt Collins 1
OVER=
This application is to be used to:apj
❑ [-molition (interior non-structural)
Heating Unit ❑ Lawn Sprinkler ❑
❑ Ventilation ❑ Water Heater ❑ Wa
manufacturer).
Complete all applicable information
Application #
Planning, Development & Transportation
3/) � C014C6�i181 N. College Ave P.O. Box 580
�/ Fort Collins, CO 80524
Cj^ Phone 970-416-2740 Fax 224-6134
E-COUNTER PERMITS ONLVAir
ly for the following permits only (check all that apply).onditioning
I Electrical_ Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Aobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
!r Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
application. Incomplete applications will not be accepted_
Date D ice— 15
sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone
t
17)0�
O�
G
_ EC� O Q
Applicant NameAddress
City/State Zip
Phone
er P
C
0 .Z41 & 9&o
Contractor
Lic #
Address
city/state Zip
Phone
Contractor City of Ft. Cc
ns Sales 7a
#
Are you paying taxes here or by report?
❑HpKe eport
Sales'ji" Lax number is
31 ni 0 2=
Are you paying with.your trust account?
es 0 No
Jj
Is this a residential or eraal p%
If residential, is it: Utingle Family
❑ Multifamily (a
If commercial, is it: ❑ Hank ❑ Bar
❑ Restaurant
Is this building 50 years of age or m
If this is for a demolition permit, wl
If prior to 19751 you mll need an rite
Description of work
cif lawn sprinkler/bacidiow preventer,
Subcontractors: List the company n
Electrician
? 'Residential ❑ Commercial
tached ❑ Condo/townhome (single family attached) ❑ Duplex
tment) ❑ Garage
7 Church 13 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
7 Other (explain)
!? ❑ Yes ❑ No if yes, you mayneed to contact Historic Pra5ervaaon
year was the building constructed?
IS assessment to submrr with this application.
plumber. If first-time A/C, must list licensed
or Cky of Ft Calms license #
Mechaniol Roofer
I hereby aclmowledge that I have read this application and state that the above information is complete and correct I agree to
comply with all requirements contained hgein 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 Marne-
nAOY Signature _ Date
i