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HomeMy WebLinkAbout679 MANSFIELD DR - APPLICATIONS - 6/7/2013FROM :NCA FAX NO. :9702299983 Jun. 07 2012 03:57PM P2/3 Fort Collins 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 ONLYAir This application is to be used to apply for the following permits only (check all that apply). Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log • Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Woodipallet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable Information on the application. Incomplete applications will not be accepted. Application # 13 1 3a 2 g For office use only Job Site Address Date t.0- _)``_ 1 123 Value of Construction (labor, materials, profit) Property Owner Name V Address City State f L- Zip` Phone J L J_. Applicant Name Address CI tate Zip Phone Contractor Address Gty/State Zip Phone GAD Contractor City of Ft. Collins sales Tax # Are ybu paying taxes here or by report? tl Here XReport Sales teXnumberisrequlredbyall conrr :tors Are you paying with your trust account? IKYes ❑ No drt l.n(� Z _ Is this a residential orcomercial project? 0'Residential ❑ Commercial If residential, is it: j`Single Family Detached ❑ Condo/townhome (single family attached) © Duplex - L3 Multifamily (apartment) 0 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 XNo if yes, ynu may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? If plior to 1975, yoll will need an asbestos assessment to submit with this applicatlon. Description of work *If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Llst the company name or City of F? Collins license 0 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.