HomeMy WebLinkAbout2913 Silverwood Dr - Permits/Mechanical - 04/09/2019 (2)FCity of Planning, Development, & Transportation Services
ort 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). IXAir 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 #
� �gc)":)'C-kaq
For office use only
Date y 18 In
Job Site Address (required) Value ofConstruction (labor, materials, profit)
r��jj
Property Owner Name Address City/State Zip Phone
A 13 SIMM006 dam. • R- 0111M MRS 6n0- U4-
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
l � • Loy9ft S3? M' I S'
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 ❑ Commercial
If residential, is it: 11Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other ( xplain)
Is this building 50 years of age or more? ❑ Yes�No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
I IQ WON
�4:WVU
*If lawn sprinkler/backflow 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
luQQlllll 111✓U Signatu
Print Name: r Date 44
Revision date 216t2017
v