HomeMy WebLinkAbout1401 E Stuart St - Applications/Mechanical - 03/06/2012Fort Collins
Ciof
Planning, Development &Transporttation
281 N. College Ave P.O. Box 580
Fort Collins, CO 8OS24
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) ❑ Electrical Alteration (not service change) ElGas LighterE3Gas Log
EpHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line . O Photo -voltaic
.13 Ventilation O 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 # 6 [c)-o
For office we only
Date & 1p\\"a
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
_6O
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? O Here
ld Report
Sales tax number is mquircdby all conrracm s.
Are you paying with your trust account? Af Yes
13 No
Is this a residential o commercial project? residential ❑ Commercial
If residential; is it:ingle Family Detached ❑ Condo/townhome (single family attached) O Duplex
O Multlfamily (apartment) ❑ Garage
If commercial, is it: O Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes 0 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, ynu willneed an asbestos assessment to submit with this application.
Description of work
it lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Qy of Ft Collins license jr
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.
Applicant -
Print Print Name: ` \rICD\e I U`y"M Signature,.." di6iL e Date
l00/l00'd ESEN W 90 ZIOZ/LO/EO ELOZESVOL6 aIV A01TQA aapn0d:u0aJ