HomeMy WebLinkAbout833 Gallup Rd - Applications/Furnace - 07/03/2013City Of Planning, Development & Transportation
�Y 281 N. College Ave P.O. Box 580
olrt Collins 7 ] I 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation 0 Water Heater ❑ Water Line ❑ 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 # 1` 3y 331 L Date 77/05 3
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
633 6&11 $ ate=
Property Owner Name Address
City/State
Zip Phone
30020
.lo«
Applicant Name Address
City/State
Zip Phone
Contractor L(ic # Address
City/State
Zip Phone
11
EAC U n=a\ LOX.470-
?31i'�'O
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ffi Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project? WResidental ❑ Commercial
If residential, is it: F Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes JZNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to.submit with this application.
Description of work'
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electridan 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 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: c'
Print Name�VB'�61166
Date Wo3/l3
A