HomeMy WebLinkAbout4318 SHADOWBROOKE CT - APPLICATIONS - 5/1/2014APR/28/2014/MON 02:53 PM Delta Mechanical Inc
FAX No,866-692-5275
P. 002
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FortCollins
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
13 Demolition (interior non-structural) CI Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Q Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable informatlon on the application, Incomplete applications will not be accepted.
Application # S 140 21 OS Date MA%l m - 201 !!I-.
For office use only
.lob Site Address (required)
Value of Construction (labor, materials, profit)
113"j . OL
Property Owner Name Address
City/State Zip Phone
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A plicant Name Address
Clty/State Zip Phone
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City/state Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you
paying taxes here or by report? PlAere ❑ Report
sales�36requiredbyallcon&adom Are you
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paying with your trust account? mrYes ❑ No
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
C3 Multifamily (apartment) ❑ Garage
If commercial, is it: O Bank ❑ Bar ❑ Church Dl Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (exfR�lain)
Is this building 50 years of age or more? ❑ Yes i No tf yes, you may need to contact Histor c preservatlon
If this is for a demolition permit, what year was th building constructed?
Yprior to 1975, you will need an asbestos assessment to submit with this appllcatlon,
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 11hinse
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. ^ -
Applicant: --brC+��o1 k-�S
Print Name:
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