HomeMy WebLinkAbout918 Butte Pass Dr - Applications/Furnace - 12/07/2012Cit } Fort
Planning, Development & Transportation
Fort Collins �q� For N. College Ave P.O. Box 580
u ` Collins, CO80524
Phone 970-416-27402740 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 ❑ Gas Log
OR 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 on the application. Incomplete applications will not be accepted.
Application # ') (�-y��35 Date f 9,-2 0 a�
For oliice use only 1
Job Site Address (required) Value of Construction (labor, materials, profit)
L44h' $ l S
Property Owner Name Address
9/?- 63� � t, pp5 or
City/State
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Zip
�vS36
Phone
92o-al9 3fa
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Applicant Name Address
City/State
Zip
Phone
S/// J k Gc_ �T
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9"?0-5ue-y0 ro
Contractor Lic # Address
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City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
N Here ❑ Report
Sales tax number is required by all contractors: Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? EXResidential ❑ Commercial
If residential, is it: 6 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 SO years of age or more?. ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work _" 0 1122e42/,1r,-- Ek iy\
*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 Plumber Mechanical d 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: ' ✓I t� ` n 0 1
Print Name:Signatu Date Ov / Cri J