HomeMy WebLinkAbout1512 Brentford Ln - Applications/Mechanical - 05/22/2012FOrrt Collins
City of
Planning, Development & Transportation
281 N. College Ave _ P.O. Box Sao
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). T 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 # 6 � °R-0305
For ofte"onty
Date &W��3►
lob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip - Phone
Applicant Name 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 IM Report
Sakw tax mmderisrevLd,edbyall czracrax Are you paying with your trust account? XYes ti No
Is this a residential or commercial project? idential Commercial
If residential; is it: ❑ Single Family Detached ❑ Condo/townhame (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 O No If yes, YOU may need to contact Historlc Preservation
If this is for a demolition permit, what year was the building constructed?
tfpnor to 1975, ytw willneed an asbestos assessment to submit with this application.
Description of work
•It lawn spnnaer/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City ofht Collins rcense o
Electrician Paj ,&rho 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: /1 `y
Print Name:5) CLQ\Q GhQ)i%VW. Signature a )n� Date
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