HomeMy WebLinkAbout2200 Clearview Ave - Applications/Mechanical - 02/27/2012FEB-28-2012 08:32 From:Allen Service 970 484 4448 To:92246134 Pa9e:12/12
City of
� ors Collis
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER -T IE-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) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation O Water Heater 0 Water Line O 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 # 12v I�
For office use only
Date .7S-00
Job Site Address (required)
Value of Construction (labor, materials, profit)
J )_a`D ,l&
d & 140, ov
Property Owner Name Address
City/State Tip
Phone
Ra 5�,�-brit 5�� tr-d(o"r . F GJ 105a-15-
lo. 40oq-
Applicant Name Address
Sh-�,•rri lot S.
City/State Tip
co -e?o5
Phone
48 8
Contractor Address
Oty/State Zip
Phone
•h CO Toss
q84/-4/g /
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here Report
Sales tax number is required by ail cowtraebws.
Are you paying with your trust account? IK Yes Cl No
Is this a residential or c mmercial project? )q Residential 0 Commercial
If residential, is. it: Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical oftice ❑ Office O Retail
0 Restaurant ❑ Ooler (explain)
Is this building SO years of age or more? FQYes ONO If yes, you may need to contact H/storlc Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
urnacc,
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City offt Collins license 0
Electrician Ih ' ` C. 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.
Applicant:
Print Name: Signatur Date