HomeMy WebLinkAbout900 E PROSPECT RD - APPLICATIONS - 2/7/2014Cit�+y}bf Planning, Development & Transportation
281 N. Coege Ave
/ F6 1� ..C6111n5 Fort Co I ns, CO 80524 P.O. Box 580
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). LolAir 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
❑ 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# JI1700ATI6 Date -7,N
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
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Contractor Address
City/State Zip
Phone
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2 05Zq5l,'?-10146
Contractor lCity of Ft. Co ns Sales Tax #
Are you paying taxes here or by report? ❑ Here
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Sales tax number is required a#contractors.
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Are you paying with your trust account? ❑ Yes
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Is this a residential or commercial project? ❑ Residential Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apart��nt) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar WChurch ❑ 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 Historic Preservation
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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license /# r/
Electrician Plumber Mechanical 'Z9OoRoofer 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: 11 -``
Print Name_ QNYitSt�ignature
City of Community Development & Neighborhood Services
Fy} I 281 North College Avenue
or` Collins Fort Collins, CO 80524
/ 970.416.2740
Over the counter permit info sheet for. -
New and replacement hvac roof -top equipment, furnaces, and water
heaters ; �
The following information must be included to approve the permit. Check all that apply.
1. Roof=tog equipment and furnaces:
Replacement of existing equipment.
❑/New/additional roof -top equipment.
qi Equipment is the same weight or lighter and similar or smaller size/footprint.
❑ Equipment is heavier and will provide engineered documentation showing roof can
support new equipment or modifications that must be done to support such
equipment.
1vl*�Replacement equipment is in the same location and not taller than previous.
❑ Replacement equipment is in new location and/or taller.
❑ For New equipment. See attached engineered documentation showing roof can
support new equipment or modifications that must be done to support such
equipment.
❑ Ground or floor mounted.
2. Hot Water Heater:
❑ Replacement
❑ New
❑ Same size or smaller than previous.
❑ Larger than previous water heater.
❑ If for a restaurant I have approval from Larimer County Health Dept for minimum
water heater capacity.
3. All equipment/appliances must be installed in compliance with 2009 IMC, IFGC, IPC, and
2011 NEC.
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pplicant signature and date
I (Form updated 1-18-2013)