HomeMy WebLinkAbout6808 Antigua Dr - Applications/Mechanical - 01/31/2012i 01/'31/2012 16:31 9702329739 1 PAGE 02/03
planning, Development lit Trainsportation
281 N. College Ave P.O. Box SW
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-TNE-COVNTER PERM ONLY
pAirCondRioning
This application is to be used to apply for the following permits
p 1'Ition (interior non-structural) Q Electrical Alteration (not service change) ❑Gas Lighter D Gas Log
eating Unit I7 Lawn Sprinkler O Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation O Water Heater O 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 #.-_ �o —
For office use only
lob Site Address (miquired) 1
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Date
value of eonsbuctlon(labor,materials,
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61110% j
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Property Owner Name
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Address
City/State
Zip Phone
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Applicant Name
13
P-8ZY Address
City/State
Zip Phone
Ca 8o�3-7 970. 3 �1o07-
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Contractor
Address
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City/State
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Zip
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663 yuoz
A1be�+J-+s Out: 40-11 Li 1 DEwut�
Are you paying taxes
here or by report? ❑Mere
lteptirt
Contractor City of Ft.
Collins Sales Tax #
Are you paying with your trust account?' Yes
❑ No
sales rar number S requ/red by all coniracror5.
J
Is this a residential or co mercial project? .ol Ke�d� al D Commercial D Duplex
If residential, is n: ched
,undo/townhome (single family attached) .
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: 0 Bank D Bar D Church O Hotel/Motel 0 Medical office D Office D Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No If yes, you may need to contact Historic Pnrslelvatron
If this is for a denwlition permit, what year was the building constructed?
If poor to 1975, you will need an asbestos assessment to submit with this applicatlon-
Description of wort(
"If lawn sprinkler/baddbw Presenter, must list licensed plumber. If first -brae A/C, must list licensed elecMdan.
Subeontractors.. List the company name or Cily of Ft Collins lirense R
Ek�nndan� Plumber _
MechanKal,^_,._� Roofer ��.- Other.
I hereby aduwwledge that I have read this application and state that the above information Is compleoe nna u" n 71 know *halt a
complyw" all requirements contained herein and city ordinances and slate laws regulating buildln constrvcW -
permit is not valid undl R has been paid and bsued.
Applicant: (� __ I � 31- / �
Print Name: � L ` ` 1— — _. Signature ,., , .._. _ - _ �