HomeMy WebLinkAbout2220 Vassar Ave - Applications/Mechanical - 02/02/201202/03/2012 13:50 9702329739
of
Fort Collins
Planning, Development 81 Transportation
281 N. College Ave P.O. Box S80
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
PAGE 03/04
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
J%-geating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer line ❑ Photo -voltaic
❑ Ventilation D 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 # D I aLA/ 511
For Ofte use only
lob Site Address (requlred)
ZZ Z V Vdx- F4 . Cb
Date 2 - Z- — 1 z- 25.00
Value of construction (labor, materials, profit)
A Z5-6 /- OV
property Owner Name Address City/State Zip Phone
Applicant Name
fl-py Address
City/State Zip Phone
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!}ova_ 48l D�/ve�✓t
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Contractor
u_$14 Address
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/ City/State Zip Phone
Pifer L-)vt=l^Y�d0 e. ZOSZ7 Lo
613 yuoz
A 16i.�+J�-Fs ONE
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Contractor City of Ft.
Collins Sales Tax #
Are you paying taxes here or by report? ❑ Mere
Are you paying with Your trust account? )a Yes
)'Report
' 0 No
Sa/es'wrnumber is required by all Contactors.
Is this a residenlial or commercial project? IV —Residential O Commercial
If residential, Is it: �ngle Family Detached ❑ Condo/town
home (single family attached) O Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: O Bank O Bar O Church O Hotel/Motel ❑Medical office O Office ❑Retail
p Restaurant O Other (explain)
Is this building 5o years of age or more? ❑ Yes ❑ No If yes, you may need to contact HiSfGric Preservation
If this is for a demolition permit, what year was the building constructed?
Il pnor to 1975, you will need an asbes70s aSseswnent to submit with this application.
Description of work -C f cc`n—
'If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed elec"an.
Subcontractors: List the Company name or City of Ft Co"Ins license r
PlumOer,�._.,— mechanical
Roofer Other
Ekxb+c9n�� --
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 taws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: t` �; Late
Print Nam -__. — Signature __ _ _...__..�