HomeMy WebLinkAbout1137 Timber Ln - Applications/Mechanical - 07/05/2019City Of Planning, Devel®pment, & Transportation Services
,r.,F6rt CoWns Community Development & Neighborhood Services
' 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax 970.224.6134
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
l❑ 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 # 6100490
For office use only
Date 11-.5. 19
.fob Site Address (required) Value of Construction labor, materials, profit)
13"IT%FG- 60521zs
Property Owner Name Address Gty/State Zip Phone
910•
Applicant Nam ddress City/State Zip Flc' 80,508
r
Contractor Address 1 City/State Zip Phone
MMN nusk • • LA s
Contractor City of Ft. ollins Sales Tax # ►4?.15 Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is re ulred byafl contractors, Are you paying with your trust account? Yes ❑ No
1O2.'i4
Is this a residential or co mercial project? esidential ❑ Commercial
ed If residential, is it: Single Family Deta ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact H/sWt1cPreservatfon
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn•sprinkler/backflow preventer, must list licensed plumber. If firs"me A/C, must list licensed electrician.
Subcontractors: Llst tfie 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: 61 P. 5ignatur Date• 2
RfVL'dM Oet8ZWD17