HomeMy WebLinkAbout1300 Stover St - Applications/Mechanical - 04/09/2012FROM :NCR
Fort Collins
FAX NO. :9702299983 Apr. 10 2011 10:49AM P1
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Planning, Development & Transportatio.w
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) [I Electrical Electrical Alteration (not service change) Gas Lights ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 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.
Application # _ 20
for office use only
Date 4 —l2
Job Site Address (required)
Value of Construction (labor, materials, profit)
.0
Property Owner Name Address
Clty/State Zip
A.
Phone
S�aA
(`, Co s�L4
Applicant Name Address
City/state Zip
Phone
Contractorµ Address
City/State Zip
Phone q"To
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here I (Report
Sales tax number isrequ1Wbyaffconlractor.%'
Are you paying with your trust account?
IKYes ❑ No
� l,o R U> 2 ._ —
Is this a residential or pmmercial project? $ Residential ❑ Commercial
If residential, is it: JO Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explal )
Is this building 50 years of age or more? ❑ Yes ja No Yyes, you nrayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkier/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors, et the company name or Cry of Ft Collins //tense 0
Electrlrian fP .}Z _4 Plumber__ ,. Mechankal 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:
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Date