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HomeMy WebLinkAbout5715 Pleasant Hill Ln - Applications/Mechanical - 08/12/2013of FQtrt Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 60524 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 ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing C3 Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application #f_ IJ I _` b 1 Date For olw a-te only Job Site Addrem�(required) Value of Const%ruction (labor, materials, profit) Phone 70. Pr perty Owner Name Address City/state Zip �9 j ,� 57/saw l/l Ln. ���,C'• fib, Applicant Name Address ;. City/State Zip Phone Fir�Hn - 2016 rc CL A L- g`]a YAy `� L Contractor Address City/State Zip Phone J�EC 4pe Zo e. G 0 OJT �i 2 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report sa/estax number Is*unedbyanconrVOOM Are you paying with your trust account?XYes - ❑No Is this a residential or commercial project? Residential C3 Commercial If residential, is it: t(5ingie Family Detached © Condo/townhome (single family attached) O Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail, ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes 'K(No If yes, you may need to contact Historic Preservation If this is for a demolition permtit, what year was the building constructed? If piYor to 1975, you will need an asbestos assessment to submit with this application. Description of work *If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Gist the company name or Gly of Ft Collins license Of . Mectridanl611_.A J plumber. Medlankal�� 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 requirements contained herein and city ordinances and state laws regulating building construction. I know that a penult is nat valid until It has been paid and issued. Applicant: ���L��N Print Name: %t.l J Signature_ !ll���-�*�i�. Daft