HomeMy WebLinkAbout801 Rumford Ct - Applications/Furnace - 02/28/2013FROM :NCA
FAX NO. :9702299983 Feb. 23 2012 01:13PM P3/3
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,rF6rt Collins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 8OS24
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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation EI 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 # 919 0o ga 3 Date
For off/ce use only
Job Site Address (requlred)
Value of Construction (labor, materials, profit)
--
Property Owner Name %Address
City/State Zip
Phone
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Applicant Name
Address Gty/State ZIP
. Phone
Contractor
Address City/State Zip
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here XReport
sales tax number isreyuImmdbya#conaactum
Are you paying with your trust account?
Q�Yes ❑ No
Is this a residential or co merclal project? Residential ❑ Commercial
If residential, Is It; PSingle Family Detached C] Condo/townhome (single family attached) I-] Duplex
Multifamily (apartment) ❑ Garage 1
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office Q Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O 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 will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L/st the company name or City of Ft Coins license #
Electriclan Plumber___ McOadcal 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:
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Date