HomeMy WebLinkAbout2190 W Drake Rd - Applications/Mechanical - 01/04/20176 1-10o61%q'I i111606 6 PI-1U0'6IG� G1_1c)ooi'S I r5�_760e f ck I (�>c-7oo020
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 #
For office use only
Date ►`7
Job Site Address (required)
Value of Con truction (labor materials, profit)
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Property Owner Name
Address
City/State Zip
Phone L 70
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Address City/State Zip
Phone
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11�535- 7g
Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential K"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 CZ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ 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
*If lawn sprinkler/backfiow 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.
Applicant: Print Name- I e 'ignatu to 1t"��
(�1-7o0o1,4 i3���u��s i3i-�u �U , 311700 1g� g,-70001" , 6 1-7000zo
C=nM=ky Deadop nod &
Fort Collins 2ft `BSM
Fort CC s, CO 80524
Ph=:970.416.2740 FM:970.224.6184
www.fwv am
Over the counter Rgrmft Information sheet for:
New and mRlacement Commercial HVAC roof -too_ uloment< furnacGS.
and water heaters
The following information must be included to approve the permit. Check all that apply.
1. Roof -top heating/cooling/ventilation equipment:
® Replacement of existing equipment.
❑ New/additional roof -top equipment.
I Equipment is the same weight or lighter and similar or smaller size/footprint.
❑ Equipment is heavier and will provide engineered documentation showing roof
can support new equipment or modifications that must be done to support such
equipment.
N Replacement equipment is In the same location and not taller than previous.
❑ Replacement equipment is in new location and/or taller.
❑ For New equipment. See attached engineered documentation showing roof can
support new equipment or modifications that must be done tD support such
equipment.
❑ Ground or floor mounted.
2. Hot Water Heater:
❑ Replacement
❑ New
❑ Same size or smaller than previous.
❑ Larger than previous water heater.
❑ If for a restaurant, I have approval from Larimer County Health Dept. for
minimum water heater capacity.
3. All equipment/appliances must be installed in compliance with 2012 IMC, IFGC, IPC,
and 2014 NEC.
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v� Applicant si a a d date
Permit number
(Form updated 01.08.2014)