HomeMy WebLinkAbout2449 Yorkshire St - Applications/Mechanical - 04/08/2014Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
FortCollinsIFort 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
54 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.
Application # Fmol bau
For offlce use only
Incomplete applications will not be accepted.
Date ano _
Job Site Address ( uired)
Value of Construction (labor, materials, profit)
2Z4 -
Property Owner Name Address
city/State Zip
Phone
-1 6 �_I S
,S-hfrwe .-f 'rL 20571
116421S
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
\MW 0Af_ - Ux
R J03
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here DKReport
Sales tax num r requir by all contractors.
9 7
Are you paying with your trust account?
❑ Yes ZNo
Is this a residential or commercial project? 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)
Is this building 50 years of age or more? ❑ Yes RMo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? N ( 4
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 licensee'# + 12 34 0
Electrician I'Kr✓ � �U Plumber Mechanical M - 1637 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: j
Print Name l Signature
Date d t
113
F95�