HomeMy WebLinkAbout648 S COLLEGE AVE - APPLICATIONS - 6/29/201706/29/2017 16:15 93032899886 MAI MECHANICAL CORP. PAGE 02/02
ciity�of Planning, Development, & Transportation Services
Fo ` Weil$ Community Development & Neighbofiood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970.4162740 Fa)c 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air CondlimfM
❑ 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 4Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applicationsf will not be accepted.
Application * t)ff b 1A(0 I Date _TT
ror afte reofry
lob Site Auidresis (rrawred) Value of Conduction (labor, materials, Profit)
b440 S. G(k a Ave- $1 1 So'2
Property Owner Name Address aty/State Zip Phone
bnuvic+ aM kK 131 60 9. Copt Ave. FT- &qlA Co . 80524 g104 Z
Applicant Name Address city/State Zip Phone
A3 tA4kk1J C t, • 4475 NAwterct 6 CO.00022 0!03 25i-13 rb
Contractor Address City/State Zip Phone
nw\e
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report?)d Here ❑ Repot
S estwnwndersregLwWbyaMavdracMm Are you paying with your trust account? ❑ Yes 0 No
* Ond34 z31
is this a residerltlal or commercial project? ❑ Residential ❑ Commercial
If residentlal, Is It 0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: Bank 0 Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
R Restaurant ❑ Other (explain)
Is this budding 50 years of age or more? C Yes )[No If kvs, y m may need W Contact Ha, wk Premvvabon
If this' for a uiemolition permit, what year was the building oonstructed7
Description of work 49 VAc tN6.9u, VUJIEGIIks'
AU '
*If lawn sprinlder/baddlow preventsr, must list licensed plumber. If first-time A/C, must list licernsed electiidam
Subcontractors: lot the mmpany ►aw or QYy of Ft CoRk s &wise #
gem MWranical Roofer Other
I hereby acknowledge that I have read this application and slate that the above information is complete and correct I agree to
comply with all regwrements contained herein and city ordinances and slate laws regulating budding construction. I brow that a
permit is not valid until It has been paid and rued. o /�
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