HomeMy WebLinkAbout1909 Seminole Dr - Applications/Mechanical - 03/15/201203/16/2012 14:07 9702329739
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planning, Development & Transpatstion
City of 281 N. College Ave P.O. Box SW
Fort Collins 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). Ir conditioning,
0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Light Gas Log
❑ Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line 0Ph
mak�mcodel and
0 Ventilation O Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide
manufacturer).
Complete all applicable information on the application.
Application # 2 01 1
For oftv use only
3ob Site Address rrmulreld)
Property Owner Name
Applicant Name
EI-1W
A\bc.nrl�4s CNE
a -
Contractor
N _ $24
A X6^c�-+3 OwE
40.'
Address
SV*"+A--
Incomplete applications will not be accepted.
Date 3 - 2` pC ✓ - 00
Address
48-1 bENVEI,
Address
bcwvr, Aber -
Contractor City of Ft. Collins Sales Tax #
Sales Di numberS re0u/red by all COnvactors.
Value of CongbuCtiOn (labor, materials, Pam)
*c1949o• °'
City/State Zip Phone
City/State Zip Phone
80
LoucCA r $37 4�1. 3 y022
Gty/State Zip Phone
L oVE th.�0 !Ls c ,) 661 '100L
Are you paying taxes here or by report? O Here
Are you paying with your trust account? IR Yes
A"Repon
❑ No
Is this a residential or rcial project? .r Kesidential ❑ Commercial
If residential, Is it: Single Family Detached O Condo/townhome (single family attached) O Duplex
O Multifamily (apartment) O Garage
If commercial, is it: O Bank 0 Bar O Church O Hotel/Motel O Medical office O Office 0 Retail
❑ Restaurant 0 Other (explain)
Is this building 50 years of age or more? D Yes ONO , yes, you may need to contact Historic Preservation
if this is for a demolition permit, ghat year was the building constructed?
Ifprior to 1975, you wdl need an asbestos asSssment to submit with this appllcadon.
Description of work yt ► 4-rnG'�o`" �'-°�-•-='~L-
*If lawn sprinkler/baddlow preventer, must list licensed Plumber- If First-time A/C, must list Ucen9ed electrician.
Subo ntractors: List the ownPany narne or City of Ft Collins license a
Plumber.— Mechanical_.--�—
Roofer , Other -----
Electr,dan
to
I hereby aclenowled9e that i have read this application and state that the above information i5 complete and correct,�that*
comply is with
all
valid requirements has been paid and i uerdinances and state laws regulating building Construction-
Per
print tint.G C , Signature —�
Print Namet�v`'"K1 — .r