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HomeMy WebLinkAbout1201 Juniper Ct - Applications/Furnace - 10/23/2012OCT-23-2012 09:20 From:Rllen Service City of Fort Collins 970 494 444e To:92246134 Page:3/13 Planning, Development & Transportation 281 N. College Ave P.Q. Box 580 Fort Collins, CO 80524 Phone 970-416.2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning ❑ Domolition (interior non•structurA ❑ Electrical Alteration (not service change) O Gas Lighter Cl Gas Log seating Unit O Lawn Sprinkler 0 Mobile Home replacement © Roofing 0 Sewer Line. C1 Photovoltaic /Cl V_entilation P Natcr Heater Q Water Line ❑ Wood/Pellet Stove (must be SPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # PPo0(0 J q6 Date Far office use only Job Site Address lrecwred) n Value of Construction (latror, materials, profit) /a0 ► _ ��n/'Pa ('r trC_ C_ d So5al _ 15-171 o0 Property Owner Name Address Caty/state Zia Phone Applicant Name ' Address City/State Zip Phone 11561 l nr1 F4,6uOt 160 1 >-214' 210.494,4941 Contractor Address City/State Tip Phone AI (w s, Sr lA,,M&1.IA!' gro541 qgq_ qg411 Contractor City of Ft. Collins Sales Tax of Are you paying taxes here or by report? �a�,{ Mere P(Report sees ray number n regLved by as cwtracrarx Are you paying with your trust account? YA Yes ❑ No Is this a residential or mercial project? esidentlal O Commercial If residential, is it: Single Family Detached O Condo/townhome (Single family attached) El Duplex ❑ Multifamily (apartment) . ❑ Garage If commercial, is it: ❑ Bank Cl Bar ❑ Church ❑ Hotel/Motel ❑ Medical office • ❑ me O Retail 0 Restaurant 0 Other (ex laln) Is this building 50 years of age or morel ❑ Yes No r1 yes, yvu may need to contact Historic Preservation If this is for a demolition permit, what year was the ilding constructed? !f prior to 197S, you wi/I need an asbestos assessment its submit ►WV7 this ae�q/fcatioa l-. r Description of work, _ * If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: t&tthe companynameorOlyofRCollinslrcenseJ' l Electrician 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. J 1 r Applicant: �b,eC6 6r. 1-�� J a'Q)�-�O Print Name: Signatur Date