HomeMy WebLinkAbout1116 Kirkwood Dr - Applications/Mechanical - 07/03/2013baz90
City Of
Flirt CoW n s.
Planning, Development & Transportation
28! 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ 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 #}: ;?ice Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
97D- �2.;2 sy
Applicant Name Address.
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here Report
5ales taxnumberisrequired by all con&actcm
Are you paying with your trust account?
❑ Yes )ifNo
[If
s this a residential or commercial projects Residential ❑ Commercial
residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) *uplex
❑ Multifamily (apartment) ❑ Garage
commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
.'EI:Restaurant ❑ Other (explain)
s this building 50 years of age or more? 0 Yes ❑ No Ifyes, you may need to contact Historic Pre a at On
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:List the company name or City of Ft Collins license Y
ElectriciaAn r& 4 Plumber Mechanical 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
permit is not valid until it has been paid and issued.
Applicant:
Print Name: K rW1,K Signature Date