HomeMy WebLinkAbout2960 W Stuart St - Applications/Furnace - 02/06/2013FROM :NCA
FAX NO. :9702299983 Feb. 07 2012 02:'35PM P1/1
Fort Col[ins
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) 13 Gas Lighter 0 Gas Log
Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line FI Photo -voltaic
❑ Ventilation ❑ Water Heater Cl 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 # al a 00 _.... Date D- (_o- GD
For olfte use only
Sob Site Address (twulr )
Value of Construction (labor, materials, profit)
29 OD VJ''c�f -t'A lo3
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7
Property Owner Name Address
t City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone 4l D
✓ Y ,, ` I S
C F�- CONv S Co
2_ 3
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here KReport
salastax numberisrequired byanronrrrcmrs:
Are you paying with your trust account?
I;Yes ❑ No
Is this a residential or commercial project? P`Resi ential ❑ Commercial
If residential, is it: ❑ Single Family Detached Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Q Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes PMo 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 3975, you will need an asbesWs assessment to submit with this application.
Description of work
*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time NC, must list licensed electrician.
Subcwntracto rs: Ust the company name or City of Ft Collins license #
EledTiaan __,,;,,,,_ Plumber ___, Mechanical Roofer
Other
1 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:
Print Nam 1� Sig m G?�Q• Dat�'