HomeMy WebLinkAbout1818 Jamison Ct - Applications/Mechanical - 09/10/2014FROM :NCR
FAX NO. :9702299983 Sep. 10 2014 02:55PM P4/4
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 854
Phone 970-41616-2740Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). CAir Conditioning
❑ Demolition (interior non-structural) CI Electrical Alteration (not service change) ❑ Gas Lighted ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
• Ventilation ❑ Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # ��
For oft ce use only
Incomplete applications will not he accepted.
Date _ { --10 -1 g
Job Site Address (required)
value of Construction (labor, materials, profit)
Property Owner Name Address
City/State ZIP
Phone
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Applicant Name Address
City/State Zip
Phone
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Contractor Address
City/State TE}-C4iWCZip
Phone Of7rb
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? -I�iere
Q Report
Soles tax number isrequired byall conuactou.
Are you paying with your trust account? Ryes
❑ No
Is this a residential or co mercial project? .(Ikesidential ❑ 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 El office ❑ Retail
❑ Restaurant 13 Other (explain) _
Is this building 50 years of age or more? ❑ Yes f ZNo Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was tfie 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 rkense 0
Electrician 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. rf rkQ
Date 2__1a7q