HomeMy WebLinkAbout2701 Claremont Dr - Applications/Mechanical - 01/16/2014Flirt Collins
City of
Planning, DeveloplmOnt &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). El Air Conditioning
❑ Demolition (interior non-structural) Q Electrical Alteration (not service change) ❑ Gas Lighter 17 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 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 #� 1 1 w, D g
Far ofte use only
Date /// 6//q
Job Site Address (required)
O
Value of onstruction (labor, materials, proflt)
Property Owner Name
Address
City/State Zip
Phoneq?o
Applicant Name
Address
City/state Zip
Phone
Contractor
Address
City/State Zip
Phone
C LEA 2 40
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
Report
Sales axnumbelnu bererrequiredbyall mno-acrors,
Are you paying with your trust account? 1.Yes
17 No
Is this a residential or co merclal project? . Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) El Duplex
❑ Multifamily (apartment) '❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant O Other (explain)
Is this building 50 years of age or more? ❑ YesONO Il yes, you may need to contact Historic?resetwoon
If this is for a demolition permit, what year was'the building constructed?'
0prior to 1975, you w111 need an asbestos assessment to submit with this app/icatlon,
Description of. work
*If fawn sprinkler/backnow preventer, must list licensed plumber.. If. first-time A/C, must list licensed elect�iclan.
Subcontractors: ustthe company name orCifyofFtCollins Nrnase 0.
ElectrldanoI .Plumber MedYanical �%j�� 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: gn g� E
Print Name �t.4'�f7lCr—/9Q%7l/°� /���is Date