HomeMy WebLinkAbout318 E Oak St - Applications/Mechanical - 04/27/2012,�"9 717/
City of
� Fort Collins
Planning, Development & Transportation .
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) ❑ 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 # I J 0- -
For office use only
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
3'
a o
,/ / 74,0.
Property Owner Name
Address
City/State Zip
Phone
C
Li 02S
? �! 3- 02�
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
l� £
-Zs
i •� 4,1
Contractor City d Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here XReport
Sales tax number is required byall contractors.
Are you paying with your trust account?
❑ Yes No
Is this a residential or commercial project? ❑ Residential Xcommerciai
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office XOffice ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application. ; _ O 11
2.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electriciar� �1-P14 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: Gt,c -Orr Signature Date