HomeMy WebLinkAbout1406 Clementine Ct - Applications/Furnace - 10/07/2011Planning, ueveropmern ai ransporcavcn
Ciwo f 281 N. Colleg Ave P.O. Box 580
Fort CoMns Fort Collins, CO 80524
Phone 970-41E-2740 Fax 224 ci?=
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 Alleration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
❑ Ventilation ❑ Water Heater 11 Water Line ❑ Wcod/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable in`ormation on the application. Incomplete applications will not be accepted.
Application #_: / / 0 Date /(� - %-//
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for ofice use oMy
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address Gty/State Zip Phone
Applicant Name Address . city/State Trip Phone
Contractor Address Clty/StaatZip
p Phone
614 Aim o,ol kSmnkew St R- L ins 6ip2525
Contractor City of FL Collins Sales Tax ;# Are you paying taxes here or by report? ❑ Here Report
Sales faxnumberkrequhedbyall mn&adors Are you paying with your mist account? ❑ Yes No .
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Is this a residential or commerdal project? residential ❑ Commercial
ff residential, is it Family Detached ❑ Condo/townhbme (single family attached) ❑Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church .❑ Hotel/Motet ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
is this building 50 years_ of age or more? Yes No If yesyou, mayneed to contactNistodc Presenadon
If this is for a demolition ❑❑ permit, what year was the building constructed?
Ifprior to 1975, )rou will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/badki'low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Qy of ft Coirras Scene ;F
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and stite 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. I know that a
permit is not valid until it has been paid and issued.
Applicant:
I�—l—Signature Date