HomeMy WebLinkAbout3006 Garrett Dr - Applications/Mechanical - 06/14/2012Fort Collins
Planningr 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 tlhe, application. Incomplete applications will not be accepted.
Application # J� 3`� `� a' Date
For oJiice use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
Applicant Name `r Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report
Sales lax number isrequ&edbyadmrrb'actam. Are you paying with your trust account? XYes Q No
Is this a residential or commercial project? W-esidential ❑ Commercial
If residential, Is it; hNingle Family Detached ❑ Condo/townhome (single family attached) O Duplex
❑ Muitifandly (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant 17 Other (explain)
Is this building 50 years of age or more? ❑ Yes CI No If yes, you may need t contact HIMnr/C Pn tvadon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wl/l.need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinlder/back low preventer, must list licensed plumber. If first-time A/C, must fist licensed electrician.
Subcontractors; List the company name or City of Coffins license f
Electrician Plumber Mechanical Roofer oar
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
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