HomeMy WebLinkAbout1224 Twin Oak Ct - Applications/Mechanical - 05/05/2014 (2)From:
05/05/2014 05:06 #045 P.001/002
City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6r }} l Collins Fort Collins, CO 80524
J 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 0 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 # �3 M D Z(12_l u Date
For olfte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
C\ s \5-
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
on Q12
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere
.Report
Sales tax numbffIsmgmredbyaucarrrraaors
Are you paying with your trust account? KYes
13 No
Is this a residential or commercial project? gResidential ❑ Commercial
If residential,- is it: IPSingle Family Detached ❑ Condo/bownhome (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 If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Ifphor to 1975, you W11 need an asbestos assessment to submit with this application.
Description of work
11 lawn sprumierroaomow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Collins license #
Electridan'o��;kZh\�cktC Plumber Mechartical 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 NameyM SignatureDate VA5 14