HomeMy WebLinkAbout1531 W Swallow Rd - Applications/Furnace - 10/06/2011City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
ort Coltins Fort Collins, CO 80524
++� 1 Phone 970-416-2740 Fax 224-6134
OVEIJ-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 -strut oral) ❑ Electrical Alteration (not service change) Q Gas lighter 0 Gas Log
eating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line _ ❑ Photo -voltaic
�j Ventilation O Water Heater Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable inforriation on the application.
Application # l6 (3
For ob9ce use on
Incomplete applications will not be accepted.
Date /D-fp-//
Job Site Address (required) Value of Construction (labor, materials, profit)
o • *, M15610
Property Owner Name Address City/State Zip Phone
r7q-�(5a a
Applicant Name i Address City/State Zip - Phone
Contractor
Address City/state Zip Phone
r h s, w5cgj ` 741— qT411
s Tax # Are you paying taxes here or by report? ❑ Here XReport
actors Are you paying with your trust account? X Yes O No
Contractor City of Ft. Collins Sal
Sd/es tax number d irmA d by al/ cont
Is this a residential or commercial
If residential, Is it: ❑ Single Fa
❑ Multifamily
If commercial, is it: ❑ Bank ❑
❑ Restaura
project? Residential ❑ Commercial
Ily Detac ed >5Condo/townhome (single family attached) ❑ Duplex
(apartment) ❑ Garage ,
Bar O Church El Hotel/Motel 11 Medical office ❑ Office O Retail
t O Other (explain)
Is this building 50 years of age ar
If this is for a demolition permi
Ifprior to 1973, you will need an
more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
, what year was the building constructed?
7sbestos assessment to submit fh this application.
Description o work
f l
'
*If lawn sprinkler/backfiow prevent
r, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lisr the company
name or City o1rFl Collins license 0
Electrician Murrill
lad
Mechanical Roofer Other
I hereby acknowledge that I have r
comply with all requirements contained
permit is not valid until it has been
this application and state that the above information is complete and correct. I agree to
herein and city ordlnances and state laws regulating building construction. I know that a
paid and issued.
Applicant:
Print Name:" '�rrl
Signatur Date
6,2:a6ej t7£T917226:01 et" t7et, 01L6 ao?njas ualld;woJJ £2:01 Zi02-eo-1:)fJ