HomeMy WebLinkAbout4115 Cedargate Ct - Applications/Furnace - 09/04/2013FROM :NCA
FAX NO. :9702299983 Sep. 04 2012 09:23AM P2/2
City of Planning, Development rk Transportation
y 281 N. College Ave P.O. Box 580
Fort Collins Fort Colllns, CO 80524
Phone 970-416-2740 Fax 224-6134
OVEWTHE-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 ❑ 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 # I P_ Date
For office use only
Job Site Addre s (Jwulre V
Value of Construction (labor, materials, profit)
'
6
Property Owner NamNamdJ
City/stater Zip
Phone
t ,A1ddress
(�
Applicant Name
Address V city/State Zip
Phone
Contractor
Address City/State Zip
Phone 01-Yo
%2. S e- Ft coil La
2-3
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here *eport
Sales tax number isfequired byai/contracAxs. Are you paying with your trust account?
t(Yes ❑ No
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Is this a residential or c9mmercial project? 21 Residential ❑ Commercial
If residential, is it: P 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 (explai )
Is this building SO years of age or more? ❑ Yes FNo If yes, you mayneed to contactHistoncPteservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/baddlow 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 9
Electrician Plumber Mechanical_ _— Roofer Other
I hereby acknowledge that I have read this applicatlon and state that the above Informatlon is complete and correct. I agree to
comply with all rNulrements 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:
Print Nam
Date 9—`41 —