HomeMy WebLinkAbout1825 W Mulberry St - Applications/Mechanical - 09/12/2017FCltyof Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins. CO 80524 Main 970 416 2740 Fax 970 224 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 applications will not be accepted
Application # I J 1-105-�4 J Date
For afgce use ony
i ob Site Address (requ/red) Value of&onslhv/c�Nyonn (labor, materials, profit)
W
pe
Own Na, ,) Address CI /S 1 hZip Phone (01
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Applicant Name Address aty/State ZIP Phone
Fort Collins Heating & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970 484 4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970 484 4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here % Report
Sa@stax Amber Is nsyuvMe a#mntractcvx Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commerdal project? 06 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 (ex lam)
Is this building 50 years of age or more? 0 Yes lR No If yes, you may need to contactHistonc Preservation
If this is for a demolition permit, what year was the building constructed?
Descnption of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Sul hcomrectors themmpanyname orGtyofRCollins Ikense0
iI
6erbtoa"c�nM Plumber Medhamral H1309 Roofer Other
I hereby admowledge 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.
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Print Name.Signature Date �_
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