HomeMy WebLinkAbout1200 Silk Oak Ct - Applications/Furnace - 01/28/2013FROM :NCR
FAX NO. :9702299983 Jan. 29 2012 01:20PM P1/3
FCioege Ave �t+y}of Planning, Development & Transportation
281 N. l Collins Fort ColCns,, CO 80524 O. Box 580
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 ❑Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O 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 t e application.
Application # Ao3vy 3c14
For oRke ase only s 1' s QO
Job Site Address (required)
Owner Name
no
Address
Incomplete applications will not be accepted.
Date
Value of Construction (labor, materials, pront)
I''X_'n,
City/State Zip Phone
Applicant Name
Address
City/State
Zip
Phone
Contractor
Address
City/State
zip
Phone 9._)40
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all canbactors
—(P 2-- W
Are you paying taxes here or by report? ❑ Here XRel
Are you paying with your trust account? IXYes ❑ No
Is this a residential or co mercial project? 16 Residential ❑ Commercial
If residential, is it: Single Fam11y Detached ❑Condo/townhome (single family attached) ❑Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ eank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical office Q 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 wi// need an asbestos assessment to Submit with this application.
Description of work (4
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; LlstMecompany name orCltyofFtCollins licensear
Electrielan,,, __ 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 wlth 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
Data /`- � 2 .�