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HomeMy WebLinkAbout6244 WESTCHASE RD - APPLICATIONS - 11/3/2014NOV/03/2014/MON 02:09 PM DELTA MECHANICAL -AZ FAX No.480-898-0005 P. 003/003 CAYof Planning, Development & transportation t� `` 281 N. College Ave P.O. Box 58o ,,�.F6rt Cottin5 Fort Collins, CO 80524 i.- Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY G This application is to be used to apply for the following Permits onl y (check all that apply). ❑Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit p Lawn Sprinkler ❑ Mobile Home replacement d Roofing O Sewer Line ❑ Photo -voltaic ❑ Ventilation It 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 # Date Far office Use only Sob Site Address (required) Value of Construction (labor, materials, profit)• q. f e.t Property owner Name Address City/State Zip Phone • � s+ Q9a — — b4 Applicant Name Address City/State Zip Phone Contractor }� � Address city/State Zip Phone //IOCOAG Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report saesraxn�rp er' a, by allmn8-acto , Are you paying with your trust account? L'Yes ❑ Na dii Is this a residential or commercial project? 'Residential ❑ Commercial If residential, is it: ❑ Single Pamily Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church © Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant' ❑ Other (explai►} Is this building 50 years of age or more? ❑ Yes IYNo If yes, you may need to contact HistoricPresPJvation If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you Will need an asbestos assessment to submit with this app/lcab'on. 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 [sty of R Collins //tense x! Eleciridan 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. Applicants SignaI ,� J Print Name: �J1t � �J��S ture Data