HomeMy WebLinkAbout1422 N COLLEGE AVE - APPLICATIONS - 9/2/2014City of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 274-6134
OVEWTHE=COUNTER PERMITS ONLY
This application is to be usedjo apply for the foilowing,permits only (check all that apply). CI Air Conditioning
m Cl Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit � Lawn Sprinkler ❑ Mobile Home replacement Ll Roofing ❑ Semr Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water line i� :i/bbod/Pellei Stove (must be EPA certified, provide make, model and
manufacturer),
Complete all applicable information on the application. Incomplete applications will not be accepted.
" Application #_ 514079 76 Date
For oMm Use onlY
job Sitp Address (. q value of Construction (labor, mater is, proFlt)
Property Owner Name Address City/State Zip Phone
Applicant Name% Address CRY/State 7_i Pho e
Contractor Address City/Sbte Zip Phone
Contractor City, of Ft. Collins Sales Tax 11, Are you paying taxes here or by report? ❑ Here ❑ Report
Sake raxnunrb i gW�edGyal�coghac(ors- Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or mercial project? UZential VCortimercial
If residential, Is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) L7 Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mote( ❑ Medical office ❑ Office ❑ Retail
JRwRestaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes M No !ryes, you n7ay need to contact hlstorlc Ptwelvatlon
If this is for a derriotition permit, what year was the building constructed?
If prior to 197S, you hill need an asbestos assessment to submit With Ibis application.
Description of work �^
*If lawri spririkler/backflow prrevventer, must list licensed plumber. If first-tlme A/C, must list licensed electrician.
Subcontractors. U,st the co%o,any name or City oFR Collins licenses
� GGJJ
Elcarlclan Plumber _ Merhanicsl 4i Roofer Other
I hereby acknowledge that I have read this application and state that tale 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 k6owthat a
penrrSt is not vali u�nt�il it FM IS peen paid and i9Syed.
Applicant; /" j� ^ ' � ' C7 �•' L
DrintName. 1 Signatu �._ ,date
r
Community Development &Neighborhood Services
Cififof 281 North CDklegeAvenue
Fo
rt Collins FwlCollins, 8D524
970 �\1 `,(D-1q —Q
970.4162740 '-t
Over the counter nermitinfo sheet fort
New and re iacement hvac roof-ta a u" ment furnaces and water
heaters
The following information most be included to approve the permit. Check all that apply.
1. ROOf-top equipment and furnaces:
Replacement of existing equipment.
❑ New/additional roof -top equipment.
'zJ��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
uipment.
rplacement
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 withzi!66 IMC, IFGC, IPC, and
i 20i2
App!cantsignature.and date
(Form updated 1-18-2013)
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