HomeMy WebLinkAbout624 Armstrong Ave - Applications/Mechanical - 12/17/2014From:
12/17/2014 04:21 #480 P.001/001
City of
Z,_ t 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). ❑ Air 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 ap lica ti
Application # `► �J I �D
For office use only
p ons wdl not be accepted.
Date ta1c�\►y
lob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State zi
,, � % P - Phone
Applicant Name Address oa y
City/State Zip p Phone
Contractor Address City/State Zip
I_ .. _\ _ , t X\ A _ _ . I P Phone
Contractor City of Ft. Collins Sales Tax # rt
Are you paying taxes here or by report? Here Report
salesrarnumberisrcqurcabya/lmnaacron Are you paying with your trust account? XYes tT No
Is this a residential or commercial project? Residential Commercial
If residential, is it: CRingle 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
IfpNor to 1975, you will need an asbestos assessment to submit with this app!>cation,
Description of
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List thecomAanyname orCity ofRCollins licenseA'
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: `!1•
LcXe . " Signature, y
Date �. 1