HomeMy WebLinkAbout2343 Valley Forge Ave - Applications/Furnace - 10/30/2013City f Planning, Development tk Transportation
FY O281 N. College Ave P.O. Box 580
Qrt Collins Fort Collins, CO 854
Phone 970-416-2740Fax 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
,XHeating 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 applicatio s will of be accepted.
Application # �1�N ?/1 Date �� �� �. /.�
For ortice use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State
Zip
Phone
17-W �•�n
`v: oK . /4-6(6v
G . 8o r oz� 9 'V - L 9-�'
Applicant Name Address
Afff /D /�D/- 13b y,
City/State
Goc.�a�uQ, _
Zip
e4i 7
Phone
SZ r_ d l 7
Contractor Lic # Address
City/State
Zip
4 70 Phone
oA( � ) A fF �132 7 IfCA 13�(' [put t` , G
ps'�
S<y'- oSy %
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here I(Report
sales tax number isfwulredbyall contractors.
Are you paying with your trust account?
❑ Yes pl<No
Is this a residential or commercial project? g-Residential ❑ Commercial
If residential, is it: 9Single Family Detached ❑ Cohdo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other ( Via' )
Is this building 50 years of age or more? ❑ Yes (:Via'
If yes, you may need to contact Historic Preservation
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 wib9 this application.
Description of work
*If lawn sprinkler/bacidlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cly of Ft Collins license #
Electrician Plumber Mechanical # 13a -1 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: 811el
me: �
Print Nal Signature Date i0 Za ij