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HomeMy WebLinkAbout2637 Little Bear Ct - Applications/Mechanical - 09/11/2013City of rt Collins 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 C] Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log 'ueating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line- 0 Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable inforrma�tio/nn on the application. Incomplete applicationss will not be accepted. Application # b, O "'"1 Date For ofce use only Job Site Address (require) Value of Construction (labor, materials, profit) P� D a " 1AY67160 Property Owner Name Address City/State Zip Phone i+ 04sa. -g0Q Applicant Nam Address 5he� i f{rtJ l I SQ ►v City/State Zip k05 y Phone q7©• yg V. 8y1 . Contract or Address City/State Zip en ervl'& /o 1 s. k i AN. PC" to 306AV Phone yooy- ygyl Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Pkeport Sales tax numberisbequ by all contractors Are you paying with your trust account? )"Yes ❑ No Is this a residential or ommercial project? Residential ❑ Commercial If residential, is it: ngle Family Detac d ❑Condo/townhome (single family attached) ❑Duplex Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit with this application. Description of work 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 # Electrician 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 Nam ) i 1 • Signature N Date / —// /✓