HomeMy WebLinkAbout45 S Taft Hill Rd - Applications/Mechanical - 11/27/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services r/
281 North College Avenue C�AI3C1 �l
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 6134 V
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 U Application # nD z)oaq Date 11&!76 %
For ofte use only
Sob Site Address (required) Val a of Construction (labor, materials, profit)
ys S a�+ H ;I I
Property Owner Name Address FOZ City/State C-E- Zip 56Y Phone q7v
vec, /%Faro -
Applicant Name Addr 22-1 7 6+,City/9tate,-oOeA Zip Phone
Contractor Address City/State Zip Phone
"T•- .a z,-
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? tHere eport
Sales tax number is required byall contractors y Are you paying with your trust account? ❑ Yes -IT
Is this a residential or c mmercial project? .2R€sidential ❑ Commercial
If residential, is it ,�ingle 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 HistoricPreservabon
If this is for a demolition permit, what year was the building constructed?
Description of work cA
*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 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. Z'
Applicant: / /&Z_�z
Print Name �r�f iS /�/// �Signat Date //
Ranson date 2/0/2017