HomeMy WebLinkAbout1022 W Magnolia St - Applications/Mechanical - 05/04/2012Rues, LLC
970-619-8074 p.2
City }} of Planningr Development & Transportation
���� rr281 N. College Ave P.O. Box 580
CollinsIFort 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableinformation on the application. Incomplete applications will not be accepted.
Application # �5 I rr a-0 Q LQ(_n
For office use only
Date
30brSite Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
LoLA ► S
City/State Zip Phone
i O-
. L r tC �ltJY. _:�q 89
Applicant Name Address
N a tS OY)e, c i q84
City/State Zip Phone
e, &
WnT3 W3 4Z
Contractor Address
4'rablt
City/State Zip Phone
Q. r R) 3T- L0[�3 obZ
Contractor City of Ft. Collins Sales Tax #
Sa✓estax number isrequiredbyall mntractox
Are you paying taxes here or by report? ❑ Here Report
Are you paying with your trust account?5i Yes ❑
No
Is this a residential or commercial project? 17kesidentlal ❑ Commercial
If residential, is it: EPtfrigle 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 (explain)
Is this building 50 years of age or more? ❑ yes ❑ No If yes, you mayneed to contact AllstwicPreservation
If this is for a demolition permit, what year was the building constructed?
Ifprror to 1975, you wi// need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time AJC, must list licensed electrician.
Subcontractors: L/stthe companynameorCity ofFtCollins license #
Electrician Plumber Mechanical 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:_ Signature
Date a I'—H1