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HomeMy WebLinkAbout1025 Oxford Ln - Applications/Mechanical - 08/21/2019cny Ol` Planning, Deveippanent, & Transp®ratscn SGrviceZ Flirt Collins Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 80524 Main: 970.416.2740 F= 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 ❑ Demoiiton (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter 13 Gas Log )4Heating Unit ,p Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic 0 Ventilation ❑ Water Heater 0 Water Line ❑ WoodiPeilet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable Information on the application. incomplete applications will not be accepted. Application # Date S 2k - SO ForoArce use only Sob Site Address (required) Value of Consisructtoor, materials, p3� n n lab Property Owner Name Address City/State Zip Phone p c 5 23 • k0s(o Appllca ame Address City/stata Zip Phone 1614 A8064 4. 1 toys Contractor Address City/State Zip Phone u Contractor City of Ft tYlins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report sales taxnumberis ul2d by all contractors. Are you paying with your trust account? %Yes ❑ No lO17 Is this a residential or commercial project? XResidential 0 Commerdal if residential, is It: ❑ Single Family Detached 0 Condo/townhome (single Wily attached) 0 Duplex Multifamily (apartment) ❑ Garage If commercial, is it: 099ank ❑ Bar ❑ Church © Hotei/Motel ❑ Medical office ❑ Office 13 Retal C3 Restaurant 0 Other (explain) Is this building 5o years of age or more? ❑ Yes'❑ No ffyes , you may need to cantacrfiistaric Preservadw If this is for a demolition permit; what year was the building constructed? Desch tion of work *If lawn:sprinkler/backilow preventer, must list licensed_piumber. 79 rfirsVdme A/C, must list licensed electrician. Subcontractors: lJst&e companyname or Criy_ of Pt CWns license # blectridan_ Plumber Mechanical Roofer Other - I hereby acknowledge that I have read this application and stale that the above information is complete and correct i egree 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: Print Name:, Signature & Date- 9-21. 1ci. RftMndam4/ M7 FMpILED