HomeMy WebLinkAbout1720 Morningside Dr - Applications/Furnace - 10/18/2012FCity Of Planning, Development & Transportation
Orl CQUN. College Ave P.Q. Box 580
Ins For
It r 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), El Air Conditioning
Cl Demolition (interior non-structural) 1] Electrical Alteration (not service change) d Gas Lighter CI Gas Log
El Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 17 Roofing i7 Sewer Une 13 Photo -voltaic
❑ Ventilation ❑ Water hleater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable
inffoolrmation on the application Incomplete applications will not be accepted.
Application # dJ (�t03S_K� Date ���-._
r%X annw rr0 ary ' $
Job Site Address (reqLeaV I O,a
--�fir Value of Construction (labor, materials, profit)
r
Property Owner Na Address �JtO
�lerZ}pXr0. City/state Zp Ph
h. .r-,%Act_ i : i n _ I)r, ai..,r n nn _ one
Applicant Name
Address Clty/Stat 7Jp
F^C � Phone
Contractor Address
City/State
I._ 1 G� ��r. � n �, i zip Phone
Contractor City Of Ft. Collins Sales Tax # Are
A` ""' "'ab"arAre you paying
taxes' here or by report? 13 Here Report
I Cr N _ You paying with your trust account? V Yes 13 No
Is this a residential or commercial project? XrResidenbal
If residential, is it: 13 Single Familypeta[f 4 Commercial
❑ Condo/townhome (single family attached ❑ Multifamily (apartment) ❑ Garage ) Multifamily
If Commercial, is it: ❑ Bank ❑ aar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Offic 13 Restaurant 13 Other (explai ) e ❑Retail
Is this building 50 years of age or more? b Yes o jty 7�t/o1a},raeCY/fb [t7�td:tf Hish�>C
If this is for a demolition permit, what year was the building constructed? �� Iiprip^ tb 1975, yntr w�r> earl an axGeatis t ad"* *** &JtF �•
Description of work
*If lawn spdnkier/backfiow preventer, must list licensed plumber. If first-time q/G must list licensed electrician,
Subcontractors: t,stdrae rirkynQo'atyL Cq�rts
Eledriclan 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 requlrements contained hereln 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:�j CLgSign
Lm_
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