HomeMy WebLinkAbout1101 Alford St - Applications/Furnace - 12/11/2013From:Poudre Valley Air 9704932073 12/11/2013 15:53 #705 P.001/001
Fort Collins
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 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
TfHeating 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 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
a �C
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone `
Contractor Address
City/State Zip
Phone
1
Contractor City of Ft. Collins Sales Tax #
sales tax number areQuimdbyall mntraaws
Are you Raying taxes here or by report? ❑ Here
Are you paying with your trust account? XYes
60 Report
p No
Is this a residential or commercial project? (Residential ❑ Commercial
If residentiali Is It: ❑ Single Family Detached ❑ Condo/townhame (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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnbr to 1975, you wi/I need an asbestos assessment to submit w/th this appl/cadon.
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 Gty of Ft Collins license 0
Electrician 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: /►
Print Name:Signature�,� 4 .. Date