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HomeMy WebLinkAbout2634 Leisure Dr - Applications/Furnace - 01/29/201302/15/2010 03:43 #0588 P.001 /002 a. T �K � rr- �i ty. of Planning, Development & Transportation � o�rt Collins Fort Col Collins, 80524 Box �° 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). M Air Conditioning ❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas lighter ❑ Gas Log AAeating Unit wn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ater 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 #- 131300411 Date _ 1 99 For of% rse only 2S.00 r-.QO _._._... ---- Job Site Address (required) Value of Construction (labor, maherials, profit) Le�CA I Ire $ 1 �b U . F-U Property Owner Name Address City/State Zip Phone t4 �Xg - 0 5 /5 S. q2,01E. zi 23 z- 9cY-7 Applicant Name Address City/State Tip Phone or phlmhl M07 r c� � a� -70,- Uq Contractor c # Address City/State Zip Phone -7 5ck-mt° Co Ctor City of Ft ins Sales Tax # Are you paying taxes here or by report? ❑ H eport Sales bznumfls,,elbyall mnbadnrs Are you paying with your trust account? Qfes ❑ No Is this a residential or commercial project? ❑ Residential ❑ Commercial If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex •� �r� Pfeil 2fMultifamily (apartment) ❑ Garage If commercial, is iL ❑ Bank ❑ Bar U Church ❑ Hotel/Motel ❑ Medical office Q Office IJ Retail © Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to conmact MsWrlc Preservation If this is for a demolition .permit, what year was the building constructed? Ifpnor to 1975, you will need an asbestos assessment to submit wlffr ffils appl/caifon. Description of workI�urhti , t *If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Lill- Me company nameor(7ty of Ft Collins license # taearicaan Plumber mt/�_ _ Medtanigl� Roofer other I hereby aclaiowledge 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_ Print Alame Signature Date If- t lJ