HomeMy WebLinkAbout929 MESSARA DR - APPLICATIONS - 7/13/2017i/30/2&��-ZUIT1 l::3TPMPMFXRT TO: 19702246134 FROh1g7�4} > 07234 T-T43 P.UPIV4 • 1`41
MAIL PERMIT TO HOME OWNER ... MAIL RECEIPT TO FCHA
F&City of Planning, Development', & Transportation Services
I CothnS ommunity Development & Neighborhood Services
61 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
E-COUNTER PERMITS ONLY
This apple s to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition erior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 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 orrn the application. Incomplete applications will not be accepted.
Application #_ i I1 n.�4 Qate
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
C129 o. 1r 31`0
Property Owner Name Address City/State Zip Phone
° zck 110,seonro. Or fort 24 .5 2- 54
Applicant Name 13 Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4562
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number&required byall ronrroa" Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commr�nercial 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? [3 Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work ° n s�.rall _ C.
*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-On.Plumber Mechanical H1309 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: (Q A30 / ) l
Print Name: Jennifer Sepulveda Signature Date
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