HomeMy WebLinkAbout421 PEYTON DR - APPLICATIONS - 5/6/2014MAY/05/2014/MON 01;12 PM Delta Mechanical Inc
FAX No,866-692-5275
P. 002
City of
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 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 0 Lawn Sprinkler -0 Mobile Home replacement ❑ Roofing O Sewer Line 0 Photo -voltaic
❑ Ventilation VWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certifled, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # S1402101-1 Date b5.O1-o • 21)1g-.
For office use only
Job Site Address (required)"
Value of Construction (labor, materials, profit)
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Property Owner am�j
Address
City/State Zip Phone
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Address
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City/State Zip Phone
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Address City/5tata Zip Phoner
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Contractor City of Ft. Collins Sales Tax #
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Are you paying taxes here or by report? VHere ❑ Report
❑ No
Sales to nub requkudbyaacontractnrs
Are you paying with your trust account? 9'ges
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Is this a residential or commercial project? J( Residential ❑ Commercial
If residential, is it; ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) Q Garage
If commercial, is It: ❑ Bank ❑ Bar Q Church ❑ Hotel/Motel ❑ Medical office O Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes >L+o Dryes, you may need to contact Historic Preservabion
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit with this appl/cation.
Description of work
RRM
*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors: list the company name or Clty 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 constnutlon. I know that a
permit is not valid until it has been paid and issued.
Applicant: r — ,
Print NamerC"1�►�' ` signature pate