HomeMy WebLinkAbout3000 Ross Dr - Applications/Mechanical - 03/06/2012From:Poudre Valley Air 9704932073
03/06/2012 14:54 A381 P.001/001
City of
,,.Fort 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ 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.
�g
Application *_ Iao I I t
For office use only
Date 3 - l0 6 1 Z
Job Site Address (required)
Value of Construction (labor, materials; profit)
00 &SSbY * �r ZID
50,31- Zb
Property Owner Name Address
City/State Zip •
Phone
HUM - i o �000
rFZb tins
�o�•. �I�,y
Applicant me Address
City/5 to Zip
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
® Report
Sales bear number& required by allcvnbaCtors
Are you paying with your trust account? AYes
C1 No
Is this a residential or commercial project? 441% d ntial ❑Commercial
If residential; Is It: ❑ Single Family Detached U Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (aparbmnt) ❑ 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?
Ifjonar to I975, you willneed 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.
S ubcontractors: List the company name or Qy of Ft Collins license 0
Electrician 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.
J
Applicant: ^ /► +,,
Print Name: ` `�LQ\Q - lay (Z�A�nn Signature �� �� L _ .. �w Date 3 ilJ• I