HomeMy WebLinkAbout3749 Kentford Rd - Applications/Furnace - 11/19/2012FROM :NCR
FAX NO. :9702299933 Nov. 20 2011 04:03PM P1/1
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
Heating Unit ❑ Lawn Sprinkler 17 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
ti 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
illnot be accepted.
Application # I aO (q(_Oy Date
For of e use only
Job Site Address required) Value of Construction (labor, materials, profit)
Pnrro�rp''e�.rty Owner Name Address City/State Zip Phone
16
69::� 09�-v( `� q01 0%)Y4Q, ffr(z &�21S a�4-1z_
Applicant Name Address City/State Zip phone
Contractor Address City/State Zip
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XReport
sale` tax number isrequredbyall ccnnactors. Are you paying with your trust account? %,Yes ❑ No
I 1p (2 2—
Is this a residential or co merclal project? RTResidential ❑ Commercial
If residential, is it: Sin lie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar. ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th6 building constructed?
if prior to 1975, you wi// need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfbw 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 #
ElecMdan 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 bullding construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Nam
Date 1 I - I4--I 7�