HomeMy WebLinkAbout1707 Sagewood Dr - Applications/Furnace - 10/05/2011OCT-06-2011 08:53 From:Allen Service 970 484 4448 To:92246134 Paee:5,9
City of
ort Cottim
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
-❑_! �D�emolition (interior non -strut ural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
�ieating Unit d Lawn Sprin ler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line . ❑ Photo -voltaic
/❑ Ventilation ❑ Water Heater Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application #
For office use on
Incomplete applications will not be accepted.
Date 16' 5-11
lob Site Address (mqu/redj '
l �o e�.�.A
F c.
Value of Construction (labor, materials, profit)
c-oRos�
Pr erty Ow er Na
Address
City/State Zip Phone
Applicant Name
i
i
Address
City/State Zip Phone
Contractor
Address
City/State Zip Phone
Tax #
r �Lr�
�/' 4CO5dt 4J?4/— 4/g
Are you paying taxes here or by report? Here P(aeport
Contractor City of Ft. Collins Sales
Sales lax number is regtorgr by it/ rnn
ctaw.
�Ci
Are you paying with your trust account? )K Yes Cl No
Is this a residential or c mmerclal project? Residential O Commercial
If residential, is it: ,Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank El Bar ❑ Church ❑ Hotel/Motel ❑ medical office ❑ Office ❑ Retail
❑ Restaura t ❑ Other (explain)
Is this building 50 years of age or more,? ❑ Yes 0 No 11 yes, you mayneed to coneacrRistorle Prese"Non
If this is for a demolition permi , what year was the building constructed?
11 prior to 19.15, you will need an sbestos assc ment to submit with this application.
A
Description of work
'If lawn sprinkler/backRow
Subcontractors: Ust the i
Elcctrician
I hereby arknowledge that I have
comply with all requirements cone
permit is not valid until it has
Applicant;
Print Name:
r, must list licensed plumber. If first-time A/C, must list licensed electrician.
name or City of At Collins license d
Mechanical Roofer
Other
this applicalion and state that the above information Is complete and correct. I agree to
herein and City ordinances and state laws regulating building construction. I know that a
paid and issued.
l I n
5ignatur Date /O '5—