HomeMy WebLinkAbout1309 Rollingwood Ln - Applications/Furnace - 02/13/2013FEB-13-2013 16:44 From:Rllen Service
City of
Sort Collins
970 484 4446 To:92246134 Pa9e:3/14
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 9701116-2740 Fax 224-6134
OVER-THE-COUNTER PERM -ITS ONLY
This application is to be used to apply far the following permits only, check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structurao ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing . ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation P Nater Heater 13 Water Line ❑ WoodtPellet Stove (must be EPA Certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #—Isoosofv Date 4�-8-13
For ofce use only
Job Site
Owner
icant
Value of Construction (labor, materials, profit)
JL—EL- C 0 �fd ��5 W SJ ..57le
Address City/State To Phone
d p Address
Zip Phone
Contractor Address awstate Zip Phone
All CAA �,r•" P 101 ,illiV15. Co V05.qq ZfS4/- S
Contractor city or Ft. Collins Sales Tax 9 Are you paying taxes here or by report? 0 Here )<Rei
.rotes taxao"4,er isrequir'dby allo;ntracto2 Are you paying with your trust account? Yes ❑ No
Is this a residential or mmercl11 project? Resldentlal ❑ Commercial
If residential, is it: Single Family Detachid d Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
It commercial, is iC ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other( lain)
15 this building 50 years of age or mare? O Yes No If yes, you may need to contacrHIVoric Preservation
If this is for a demolition permit, what year was the b Ilding constructed?
If prior [0197S, you will need an asbestos assessment to submit with this opp/rcaUon.
Description of Wrk _.
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/[, must list licensed electrician.
Subcontractors: List the company name or CIty of Ft Co//ins license 4'
Plumber Mechanical koofer' Other
I hereby acknowledge that I have read this applicabon and state that the above Information Is complete and correc
t.. St..L6wthat
comply with all requirements contained herein and city ordinances and state laws regulating building cons[n ictiori'"h'khow that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: slgnatur Date a-13-1