HomeMy WebLinkAbout4404 Monte Carlo Pl - Applications/Furnace - 02/20/2013FcCity of planning, Development ff Transportation
For N. College Ave P.O. Box 580
ort G'olth
•7 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
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter El Gas Log
11 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement M Roofing CI Sewer Line 0 Photo -voltaic
❑ Ventilation ❑ Water Heater 11 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applicatlo III
Application # i3l �U-7&O
For otiice use only
Job Site Address
Value of
ns w not be accepted.
y uwllC ryame Address Gty/State Zip
-1-A%AC +h i , r . .
Applicant Name '
Address City/State
r/'zip
ISnrs r� n� _.._ ._ _ ..
v' Address Gty/State Zip
A ?DQ ('Atavaprro 461 E7-,--" A I -
Contractor Gty of FL Collins Sales Tax #
sa/ts rar nu 4e requited by al/ cantracto s
materials, profit)
Phone
Phone
Are you paying taxes here or by report? O Here 13 Report
Are you paying with your trust account? .78zY'es 0 No
Is this a residential or commerdal project?. eK-Residendal ❑ Commercial
If residential, is it; ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commerdal, is it: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 0 Other (explain
Is this building 50 years of age or more? ❑ Yes )lo lfyes, you may need to ConiactHistoriCPreservation
If this is for a demolition permit, what year was the building constructed?
Ifpr/pr to 1975, you will needan asbestos assPs�m t to submlt with this a i
PW Callon.
Description of work
'If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician,
Subcontractors: Ustthe companynameorOtyofFfCollinslicense #
Electrician,,` Plumber
MedianiralLAIA
_ Roofer Other
T hereby acknowledge that I leave read this application and state that the above information Is complete and correct. I agree to
comply with all requirements contained herein and dry ordinances and state laws regulating building construction. i know that a
Permit Is not valid until It has been paid and Issued.
Applicant:
Print Name:Mdgm
Date. Z'J • I