HomeMy WebLinkAbout815 Napa Valley Dr - Applications/Mechanical - 05/09/2012FROM :NCA
Fort Collins
FAX NO. :97022999e3 May. 10 2011 11:53AM P1i3
Planning, Development & Transportation
781 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).X.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 applicable information on the application. Incomplete applications will not be accepted.
Application # e? I 2�)Date _ S —Cf--],4
for ofhee use only
Job Site Ad ress (required)
Value of Construction (labor, materials, profit)
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Property Owner Nana Address
City/State Zip
Phone
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Applicant Name Address
CI/State Zip
Phone
Contractor Address
City/State Zip
Phone °l->ro
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here XReport
Sa/estax number &reyulredbyal/ronlractors
Are you paying with your trust account? %Yes
❑ No
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Is this a residential or commercial project? � Residential ❑ Commercial
If residential, ❑ is It: Single Family Deta Pd ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explai )
Is this building so years of age or more? ❑ Yes RrNo ryes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
11 prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Gist the company name or City of R Collins license #
ElectricianA�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 Nam
Date