HomeMy WebLinkAbout600 REPUBLIC DR - APPLICATIONS - 7/13/2012JUL/13/2012/FRI 03:48 PM DELTA MECHANICAL —NV
FCiof
ort Collins
FAX No, 702-369-9578 P. 004
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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 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation VWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be PPA certified, provide make, model and
manufacturer).
Complete at] applicableeiinformation
]On the application.
Application # I "-� �� `I° Q�
For office use only
Incomplete applications will not be acce/ptted.
Date J1A LA(T
ob Sites Ad SS (reigutlre) ,
l e of Construction (labor, materials, profit)
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Property Owner name
Address
City/State Zip Phone
Applicant Name
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Address
City/state Zip Phone
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City/State Zip Phone
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Contractor City of Ft. Collins sales Tax # Are you paying taxes here or by report? RHere ❑ Report
Sales taynu�her required byall contractors Are you paying with your trust account? Rles ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: C] Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? El Yes iVo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th¢ building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
*If lawit5 rinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or c&y 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: ,r�1t
Print Name:
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