HomeMy WebLinkAbout3000 Anchor Way - Applications/Mechanical - 01/19/2015From:
01/19/2015 07:27 0523 P_002/003
FCity of
ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 58o
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). Wit 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 # �I,dd`Alb Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
�.c way 3S�j
Property Owner Name Address City/State Zip Phone
Applicant Name Address Ity/State Zip Phone
Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # R
Are you paying taxes here or by report? Of Here .Report
Sales tar number is required by all contractors. Are you paying with your trust account?.9Yes L2No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: }Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
9[� 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 ❑ No rfyes, you mayneed to contactHistoric preservation
If this is for a demolition permit, what year was the building constructed?
rfpnor to 1975, you w111 need an asbestos assessment to submit with this applicadon.
Description of work
*If lawn sprinkler/backtiow 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 o
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: ^ r1,
Print Name: ` `_ (J:Ng Signature, Date `1