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HomeMy WebLinkAbout4332 MESAVIEW LN - APPLICATIONS - 10/15/2012Oct 1512 03:16p Hahn Plumbing 9704935325 p.1 y-� City of Planning, Development & Transportation t 6 Co l i' n s For N. Cosege Ave. P.O. Box 580. �"�`,�` t Fort Collins, CO 60524 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) Q Electrical Alteration (not service change) ❑ Gas Lighter [I Gas Log ❑ Heating Unit ❑ Lawn Sprinkler .❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line . ❑ Photo -voltaic Cl Ventilation Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application_ Application # ( � U (� I Foror7rce rat only Job Site Address (required) Name Applicant Name Contractor Contractor City of Ft. Collins Address / Address Address Tax # i nP- /' Sales tax number is rwL redbyall conbadars Incomplete applications will not be accepted. Date Value of Construction (labor, Taterials, profit) �.� o City/State Zip Phone City/State Zip Phone City/State Zip Phone Are you paying taxes here or by report? ❑ Here ;<Report Are you paying with your trust account? )<Yes ❑ No Is this a residential or commercial project? 'lgResidentlal ❑ Commercial If residential, is it: P�Singie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: Cl Bank ❑ Bar 0 Church ❑ Hotel/Mote1 © Medical office ❑ Office ❑ Retail 0 Restaurant ❑ Other (explain) Is this building So years of age or more? 17 Yes Q No Zfyes, youmayneedrb cantactHst017cPre5erva80n If this is for a demolition permit, what year was the building constructed? If prior to 1975, you wi/l need an asbestos assessment to submit with this application. Of work *If lawn sprinkledbacknow preventer, must list licensed plumber. If first-time AJC, must list licensed eiectriclan. Subcontractors:List th,-companynameorCityofftColiins�cense# Eleoridan Plumber MechaNrzl 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 -arid State laws regulating building construction. I know that a permit Is not valid until it has been paid and issued. Applicant: Print Narne. r r, 1 4 j? f— Signaturr /. T� Date