HomeMy WebLinkAbout3724 Kentford Rd - Applications/Mechanical - 07/16/2012JUL-16-2012 08:20 From:Rllen Service
City of
�6rt Collins
970 484 4448 To:92246134 Paee:4�12
Planning, Development &Transportation
281 N. College Ave . P.O. Box 580
Fort Collins, CO W524
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) ❑ t=lectrical Alteration (not service change) ❑Gas Lighter Gas Log
Heating Unit ❑ Lawn Sprinkler 1] Mobile Home replacement CI Roofing ❑ Sewer Line . O Photo -voltaic
O Ventilation Nater Heater ❑ Water Line ❑ WoodtPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the
application. Incomplete applications will not be accepted.
Application # b I av 'V) I Date t3lu - 0 O
For office use arty
Job Site Address rr uiredl Value of Construction (labor, materials, profit)
3 ;d r L �eq to 7�
Prope1W Ownpr Name A Address oity/State Zio phone
int Name Address City/State rp Phone
ri trJ� kJya* J'40.49_4-494i
Contractor Address City/State Zip Phone
/2L_S, 1, , j ► 10s44J Fq_ yg /
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? CI Here Report
Sales tax number is r"Wed by all contractors. Are you paying with your trust account? Yes ❑ No
Is this a residential or mmerclal project? Residential ❑ Commercial
If residential, is it: Single Family Deta&d ❑ Condo/townhome (single family attached) ❑ Duplex
//❑ Multifamily (apartment) 0 Garage
if commercial, is it: ❑ Bank ID Bar O Church ❑ Hotel/Motel ❑ Medical office � 0 Office ❑ Retail
D Restaurant Q Other (ex lain)
is this building 50 years of age or more? O Yes ,� No lfye`s, you may ne4d to contact Historic Preservation
if this Is for a demolition permit, what year was the tiding constructed?
!f prior to 1975, you will need an asbestos assessment to submit Ivith,Ahis applrcabon.
Description of work
*if lawn sprinklertbackflow preventer, must list licensed plumber. If first-time NC, must list licensed electrician.
Subcontractors: List the company name orCityofRCollins licenseo
El"trician Plumber. Methankal Rooter 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: ,hv-�i
Print Name
$ignatur Date