HomeMy WebLinkAbout4407 Craig Dr - Applications/Furnace - 01/16/2013Planning, Development & Transportation
ter o� 281 N. College Ave R.O. Box 580
Phone 970-416-2740 T _X ,r
This application is to be ,ZW flowing permits only (check all these rs —joining
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lightera ❑-G isrLog"=
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❑ 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# 81300a35
For o>f5ce use only
Date �1��� 1 - 17
Job Site Address (required)
Value of Construction (labor, materials, profit)
4g
Property Owner ame
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
ncontractors
Are you paying taxes, here or by report? ❑ Here
50 Report
sales tax number isregwredbyall
Are you paying with your trust account? XYes
13 No
Is this a residential or commercial project? Notesidentfal ❑ Commercial
If residential; is it: 1p 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? ❑ Yes ❑ No Ifyes, you may need to contactHistoricpresecvabr
If this is for a demolition permit, what year was the building constructed?
I on
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work, �A_Q
'If lawn sprinkler/backriow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician
Subcontractors- List the company name or City of Ft Collins Acense #
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.
Applicant: /1 I
Print Name: G�Q)11m Signatures � Date At(Allo_lp_
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