HomeMy WebLinkAbout748 Blue Mountain Dr - Applications/Furnace - 03/01/2013MAR-01-2013 16:07 From:Allen Service 970 484 4448 To:92246134 Page:5/1e
City of
Fort Collins 4
Planning, Development & Transportaticn
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). O Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Rooring O Sewer Line 0 Photo -voltaic
ElVentilation [j Nater Heater ❑ Water Line D 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 # )off f e<,Date 3-/-13
For office use, Only
JOD Site
__:Zy8 _&Ue 1114941 AIMiti je.
P Derty Owner Nam9" Address
Address
LJl
Value of Construction (labor, //materials, profit)
Gtv/State To
owstate Zip
Phone
1_60
Phone
Contractor Address City/State Zip Phone
�a11 ;OSszc�SU'- y8 I
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ here Report
Sdres tax nr rnbcr 15 regvrzd by al/ cmtradors. Are you paying with your trust account? yes ❑ No
1s this a residential or mmercial project? y"dential ❑ Commercial
If residential, is Single FamUy Detrjvd 0 Con'do/townhome (single family attached) ❑ bupiex
0 Multifamily (apartment) ❑ Garage ,
If commercial, is it: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office - ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex lain)
Is this building 50 years of age or morel CI Yes Ne Jfyrs, You rrray need to=tacr HisWrIc Preser✓affon
If this is for a demolition permit, what year was the Ilding constructed?
11rprior to 1975, you will rip et an asbestos assessment to submit with tIN appCcatlon.
Desrriptinn of Work
ten„ �pnnroer/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company nvme or City of R Collins license F'
Electrician
Mechanical Roofer Other
I hereby acknowledge that 1 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. 1 know that a
permit is not valid until it has been paid and issued,
Applicant;
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