HomeMy WebLinkAbout411 W Myrtle St - Applications/Mechanical - 01/11/2018Cityof Planning, Development, & Transportation Services
Fort 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). IJ'Air Condltiomng
❑ D m lition (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 # ') I9A0-7-:74 Date
r off7re use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner me Address City/State Zip Phone
Applica"ame Address City/State _ Zip Phone
Avy
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report
Sales tax number Isrequredbyall ronbactims Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial projects esidential ❑ Commercial �
If residenbal, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) 0-6uplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other explain)
Is this building 5o years of age or mores es ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work G� X T"�✓G�J ����a)SEA
AOD AI - 1rW-C G 21 2ew 51_1W5
*If lawn spnnkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List bie 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 regula g building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:AR�.ignature
Print Name: " " Date
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Revision date 2162017