HomeMy WebLinkAbout645 Peyton Dr - Applications/Mechanical - 10/13/2011FAX NO. :97022999133 Oct. 14 2011 10:14AM P1/1
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). 12
Air Conditioning
❑ Demolition (interior non-structural) O 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 # N109�2D ( Date I' 5 -Q0__
For ofte use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Pr perty Owner N e
Address
City/State Zip
Phone
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Applicant Nailhe
Address Q
City/State Zip
Phone
Contractor -^
Address
City/State Zip
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here XReport
Sales tax number is required by allcon&actom
Are you paying with your trust account?
Yes ❑ No
Is this a residential or co mercial project? Lff Residential ❑ Commercial
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 ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)-. T.
Is this building 50 years of age or more? ❑ Yes VNo 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.
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 +
Electrician Plumber hmchanlcal 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. I)
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