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HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 12/27/2013Dec•27. 2013 8:51AM 9704844448 ALLEN PLUMBING&HTG No•4808 P. 3/9 C.� Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Flirt Collins 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). O Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration -(not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑Lawn Sprinkler ❑Mobile Home replacement ©Roofing ElSewer Line ❑ Photo -voltaic ❑ Ventilation Water Heater Q 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 # 331 �c�-`1 Date -7-1 3 For of e use only Job Site Ad(required Value of Construction (laboraterials, profit) , � Pr rty Owner Name Address City/State Zip Phone Applicant Nam Address City/State Zip Phone ntractor filkn Simi& /o 1. Address 6M City/State Zip AN, P 6 a go a Y Phone yPy- qpl Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Ll Here Pkeport sales tax number FOrequ��byall contractors Are you paying with your trust account? Yes ❑ No Is this a residential or commercial project? residential ❑ Commercial If residential, is It: ❑ Single Family Deta d ondo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar Q Church ❑ Hotel/Motel. ❑ Medical office ❑ Office © Retail 0 Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact HlstoricPreservation If this is for a demolition permit, what year was the building constructed? if prior to 1975, you will need an asbestos assessment to submit with this application. Description of work U� ` -• *If lawn sprinkler/backFlow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician. Subcontractors: Llstthe company name orOtyofFtCollins license# Electrician I 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:CrA*) Signature JDate, V , ?ri rl 3