HomeMy WebLinkAbout112 E Laurel St - Applications/Mechanical - 05/02/2014FROM :NCR
FAX NO. :9702299983 May. 02 2014 09:43AM P5i6
Cit of
or�t Collins
Planning, Develbpmen'E at Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 zZ 3% Z
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). Q Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
XHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 13 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 #b\tU-' 1!�; --- - Date -
Far of ke use only .
Job Site Address (required) Value of Construction (labor, materials, profit)
11 _ .. cc. 1r 1A
Owner Name Address Clty/State . Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address Gty/State FV:DWMZip . Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Jollere ❑ Report
Safes raxnumber arequlmdbyall rnnrracto s. Are you paying with your trust account? es ❑ No
4RlCI4La1
Is this a residential or commercial project? ❑ ResidentialCommercial
If residential, is it: ❑ Single Family Detached ❑ Condo townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Fhurch ❑ Hotel/Motel 0 Medical qMce ❑ Office ❑ Retail
❑ Restaurant VOther (explain) _ t-f&% Y YvQ Any
Is this building b0 years of age or more? C] Yes O No Ifyes, you may need rtact Historic Pare ervatbon
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbastos assessment to submit with this application.
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subeontraetorsi List the company name or City of R Collins license 0
E1ecb1c1an W N1 4t4C , 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.
Appllcanti
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Date �a''i