HomeMy WebLinkAbout2625 Featherstar Way - Applications/Mechanical - 02/06/201202/06/2012 16:53 9702329739
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City
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). it Conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) 4 Gas Lighter U Gas Log
)"eating Unit O Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line Q Photo -voltaic
❑ Ventilation O Water Heater O 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 # Q I ;LOO Ce I Le Date Z- 6-/ Z-
For ofte use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
2 l cfy e4
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Property Owner Name
Address
City/State Zip Phone
r�n,ti, ,'� Sf
S ?PU zZ 5733
Applicant Name 11-BLtf
Address
City/State Zip Phone
Allog.ncL%As vNt �a
Lin bEt4vEIL
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Contractor u`�2`f
Address
City/State Zip Phone
A I6-011- "J ONE 901A _
4 -1 DENvcA,
ALout:I--wo e- oS3'i 01 o 60 yool-
Contractor City of Ft. Collins Sales Tax a
Are you paying taxes here or by report? O Here WReport
Saks tax number rs rKulred by all convaaors.
Are you paying with your trust account? )4 Yes O No
Is this a residential or commercial project? KResidenbal O Commerdal
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) O Duplex
❑ Multifamily (apartment) ❑ Garage
If Commercial, is it: O Bank O Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building SO years of age or more? O Yes ❑ No If yes, you may need to contact Historic Preservabon
If this is for a denwlidon permit, what year was the building constructed?
If prior to 1975, you w/il need an asbestos assessment to submit with mis applrcobon.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; List the company name or City of rt Collins license a
ielem%cian plumber____ Mechanical!-- Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correft. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I knew that a
permit Is not valid until k has been paid and Issued.
Applicant:
Print Name: ✓�� �_ - Signature --