HomeMy WebLinkAbout401 S College Ave - Applications/Mechanical - 04/09/2012Fort Collins
-Planning, Development.& Transportation
281 N. College Ave P.O. Box 580
Fort Collins, 00,80524. ; '•:.
'Phone 970-416-2740 'Fax'224-61
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Q
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation Cl Water Heater ❑ Water Line 13 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 # Date
For ofte use only
lob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
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Contractor Lic # Address
City/State Zip
Phone
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 14 Report
Sales��� �srequlredbyanaonaaao%
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential Eff Commercial
If residential, Is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: q Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes P(No ?fyes, you may need to contactHlstoricPreservation
If this is for a demolition permit, what year was the building constructed? & IA
If prior to 1975, you will need an asbestos assessment to submit wriii this appKcabron.
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gly of Ft Colfrns license 0
Electrician PROZeC"Ir! _ Plumber Mechanical be)4.4,e1Flovr 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 Name:/ f'F C v S Signature
Date �_/ / -,20/�