HomeMy WebLinkAbout7403 Stonington Ct - Applications/Mechanical - 09/27/2016From
09/27/2016 04:37 #342 P.002/ 003
F'Ort Collins
Ciof
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 1 later Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information�n the application. incomplete applications will not be accepted.
Application #B&& \
. For office use only
Job Site Address (required)
Property Owner Name
Applicant Name
Contractor
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
Date_ q�';.1I1.�
Value of Construction (labor, ateriais, profit)
Address City/State Zip Phone
Address City/State Zip Phone
Address
City/State Zip Phone
Are you paying taxes here or by report? WHere *Report
Are you paying with your trust account? XYes L7 No
Is this a residential or commercial project? Vesidential ❑ Commercial
If residential, is it: \4p 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you wi// need an asbestos assessment to submit with this appl/cat/on.
Description of wo
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors. V the company name or Cty of Ft Collins license #
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: h
Print Name: , \ ` ,�i� Signature ,,���` Date