HomeMy WebLinkAbout5219 Abbey Rd - Applications/Mechanical - 03/04/2014FROM :NCA
FAX NO. :9702299983 Mar. 04 2014 09:16AM P5/5
City of Planning, Development & transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO $0524
Phone 970-416-2740 Fax 224-6134
OVEWTHE-COUNTER PERMITS ONLY 1-7 72-
'this application is to be used to apply for the following permits only (check a❑ Gll that aply)�Air Conditioning ter ❑ Gas Log
❑ emolition (interior non-structural) C3 Electrical Alteration (not service change) as Ligph
Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑Roofing ❑Sewer Line ❑ photo voltaic
0 Ventilation 4 Water Heater 13 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 # "31 Li b 11 Li 00 Date � o
for use o
�—{ A �-
office nly
lob Site Address (required)
Z-
Property Owner Name Address
Applicant Name Address
Contractor Address
Contractor City of Ft, Collins Sales Tax #
Sales tax number Is required by all contractors,
value of construction ((labor, materials, profit)
�-:) Iew-
City/state Zip Phone
City/State Zip
City/State F+C 1( kI lCZfp
Phone
Phone C'Y )-o
Are you paying taxes here or by report? Jhoere ❑ Report
Are you paying with your trust account? KYes E3 No
Is this a residential or cc merclal project? esidential 0 Commercial
If residential, is it: Single Family Detach d ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 17 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant 0 Other (expla' )
I this building years of age or more? q Yes If yes, you may need to contact Historic Preservation
on
this Is for a de
molition 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 Gty offt Collins license #
Ooctridan 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.
I