HomeMy WebLinkAbout1125 Oakmont Ct - Applications/Furnace - 03/06/2013Fotrt ColUns �
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) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltalc
❑ Ventilation ❑ 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 # 5(3o0-0-,-10
For otAce use only
Date :2) - (a' 15
Job Site Address (required)
Value of Constry'on (labor, materials, profit)
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Property Owner Name Address
City/State Zip a PZrie
Applicant Name Address
City/State Zip Phone
F 2,09 UMMUC444
iL�D 55
Contractor Address
IFC" A tog Co mmu ce, �-I
Gty/State Zip Phone
- Fr
Contractor Clty of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑Here ❑Report
Sales nu r&requnedbyaii cw,tracras:
Are you paying with your trust account?,Ekyes ❑ No
Is this a residential or commercial project? :'Residential ❑ Commercial
If residential, is It: 1 $Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar Cl Church Q Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) '
Is this building 50 years of age or more? ❑ Yes k'Vo 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 asbestas rise sment to submit with this applfcatyon.
Description of work
*If lawn sprinkler/backflow preventer, must fist licensed plumber. If Flrst-tlme A/C, must list licensed electrician,
Subcontractors: List Me companyname orGty of Collins license #
Plumber MechanicalflI609 Roofer
Other
I hereby acknowledge that I have read this application and state that the above informadon 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 Name.ye� M
Date