HomeMy WebLinkAbout1913 Pawnee Dr - Applications/Mechanical - 06/20/2018/ Planning, Development & Transportation
FCity of B /I/�e.� f / 281 N. College Ave P.O. Box 580
®rt C®�C4�Up�, s gl_ Fort Collins, CO 80524
.� („
ry h 4 ( Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONL
This application is to be used to apply for the following permits only (check all that apply). iAir 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.
Application # PAM 14W
For oft/ce use only
Incomplete applications will not be accepted.
Date 4. - .20 —' .g
Job Site Address (required) Value of Construction (labor, materials, profit)
I�i13 �auvnee Dr• $ l ;450
Property Owner Name Address City/State Zip Phone
Dr, pp,f)9 Spr;ngs 7BT-GaD 51z- 5133-
Applicant Name Address City/State Zip Phone
Contractor UC # Address Gty/State Zip Phone
r ir'urr��� L�i. #� A/rndsor Co. 90615D 970 GBIo"lsGb'(p
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? t�ere ❑ Report
sales tax number is required by all contractors `393&/( Are you paying -with your trust account? Yes „B'No
L�6d�.'1c 84ro�
Is this a residential or commercial project? Ef Residential ❑ Commercial
If residential, is it: i°1Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motet ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes m1lo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Add 5 Duef)css ;ndaor ��' �s eznnccltd 74o / 044,do6r uri;f:
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subconb actors: List the company name or Gty of Ft Collins license
. /
Eled3 idan � r k CiC e , Plumber Mechanical Roofer Other
I hereby acknowledge that 1 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: I /Y J, , l/
Print Flame: Signature
Date ta- ZD / S