HomeMy WebLinkAbout630 WARREN LNDG - APPLICATIONS - 11/13/2015 (2)15R480
Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
; �6rt Collins Fort Collins, CO 80524
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Phone 99770-416-274400 Fax 224--66134
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 ❑ 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 # p k5®yulak Date 11/13/15
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
630 Warren Landing
$9,710.00
Property Owner Name
Address City/State Zip
Phone
Burt Denmark
630 Warren Landing Ft Collins, CO 80525
970-229-9880
Applicant Name
Address City/State Zip
Phone
IMS Heating and Air
5213 Longs Peak Rd, Unit A Berthoud, CO 80513
970-532-0123
Contractor
Address City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ❑ Single Family 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed 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 Replace ndAir Conditioning
*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 #
Electrician Eggers Elec Plumber Mechanical IMS Heating 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:
Print Name: Rita Ulbrich Signature Date 11/13/15