HomeMy WebLinkAbout3413 Camelot Dr - Applications/Furnace - 05/23/2013FROM :NCA
FAX NO. :9702299983 May. 23 2012 02:25PM P2i2
Fart Collins
Planning, Development & Transportation
281 N. College Ave P.O. sox 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
0 Pernolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit ❑ Lawn Sprinkler El Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo voltaic
Ventilation ❑ Water Heater ❑ Water.1-Ine ❑ 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 #_. 1J'302`Sri y' Date
for ofte use only
7 b Site Address (mqulmd) Value Of Construction (labor, materials, profit)
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Property Owner a Address City/State Zip Phone
Slav �P L CZ, Gp 25
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone q"Irn
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here r�_]
Sales tax number is required by all conlrectam. Are you paying with your trust account? O�Yes ❑ No
eZ :PjLe .
Is this a residential or co mercial project? Zaesidentlil ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) Cl Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes XNo 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 w/l/ 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: List the company name or city of R coldds 1/tense >r
EleMcian_ Plumber _ Mechanical__ 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 contahied 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: t J _ y��+
Print Name `G�►/'i? _ !� LSIB a7 Date