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HomeMy WebLinkAbout1531 W Swallow Rd - Applications/Furnace - 10/05/2011OCT-06-2011 08:53 From:Allen Service 970 484 4448 To:92246134 Pase:6/9 City of ort C011in Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS l7S ONLY This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning ❑ Demolition (interior non -strut Ural) 0 Electrical Alteration (not service change) ❑ Gas Lighter C1 Gas Log �ieating Unit O Lawn Sprin ler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic CI Ventilation ❑ Water Heater 2 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and _ manufacturer). Complete all applicable information on the application Application # For o/rce use on Incomplete applications will not be accepted. Date Job Site Address (required) ' Value of Construction (labor, materials, profit) r W. allow -3A Fc. co w5a(o- qel 3 -Q Property Owner Name Jack Sigss /ZPA Address WE�] City/State Zip Phone S AAS-V-rs Applicant Name Address City/State Zip Phone ' Contractor Address City/State Zip Phone p Tax # S vl 6, Co 4osdt 419f-/- 4/8 l Are you paying taxes here or by report? ❑ Here fi'Report Contractor City of Ft. Collins Sales Sores tax numberisrequiredbyall cvn actors. Are you paying with your trust account? (Ye5 ❑ NO /C) Is this a residential or commercia If residential, Is it: ❑ Single Fa © Muldfami If commercial, Is It: ❑ Bank C 11 Restaurai Is this building 5o years of age If this Is for a demolition permi lfprior to 1975, you will need an Description )5f work *If lawn sprinkler/backflow Subcontractors: List the i Electrician project? ;4esidential ❑ Commercial nily Detached undo/townhome (single family attached) ❑ Duplex e (apartment) Garage Bar O Church 0 Hotel/Motel ❑ Medical office 13 Office ❑ Retail • ❑ Other (explain) r more? 0 Yes ❑ No if yes, you iMy need to Contact i4istvriC Preservatlon , what year was the building constructed? rsbestos assessment to submit with this application. r, must list licensed plumber. If first-time NC, must list licensed electrician. name or City of Ft Collins license 0 Mechanical Rooter. Other I hereby acknowledge that I have r ad this application and state 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: \ he��l 6171 ► I If1 - /O —541 Print Name._ Signatur Date