HomeMy WebLinkAbout937 Chippewa Ct - Applications/Mechanical - 11/06/2018i
i' FCity of Planning, Development, & Transportation Services
it CoRinS 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 matte, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Date November 6, 2018
for ogre use only
lob Site Address (required) Value of Construction (labor, materials, profit)
937 Chippewa Court, FcrtCoUb 4w, CO 80525 $16667.00
Property Owner Name Address City/State Zip Phone
1tobe4t1MargamtHea 937 Chtppewa Coart FortCoWn&, CO 80525 970-484-0853
Applicant Name Address Clty/State Zipp Phone
Cfu-6W"4t,v> van. 101 S LCKkLane Ftco; CO 805Z4 494-7632
Contractor Address City/State ZiP Phone
AUerl1Servf.Ce1 101 S G,yrkLa-nz Ft Cm, CO 805z4 484-4841
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑Mere ❑ Report
Sales taxnumberlenaquirndbyall conbacto s. Are you paying with your trust account? VYes ❑ No
10010
Is this a residential or mmercial project? 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 Q Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or morel ❑ Yes ❑ No Ifyes, you may need to contact HistortcPresevation
If this is for a demolition permit, what year was the building constructed?
Description of work Rome, '�'8oilaa ui, rep lace, w Wv U4,new Baler
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or Cityof Ft Collins Acense #
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. hign&aMDate
Applicant; Chri 3tGuvi va nyPrint Name; Signature l!/
Ra Cmi date M2017