HomeMy WebLinkAbout1712 Tanglewood Dr - Applications/Furnace - 11/12/2013Planning, Development & Transportation
City of , ` _ 281 N. College Ave P.O. Box 580
FVrt Collint. 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 ❑ 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 # tll I_�05?I9_0 Date Z�hZ, Z 45
For office use only I I t T
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address City/State Zip
Phone Of %0
C.0l1-
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Applicant Name
Address City/State Zip
Phone Q?o
Contractor
Address City/State Zip
Phone 9 %0
i .r 6e-
k1l Z) W 1Z 3053Jg
-01 Z
Contractor City of Ft. 911ins Sales Tax #
Are you paying taxes here or by report?
❑ Here 1X Report
Sales tax number isrequired byall mntraccorn.
Are you paying with your trust account?
❑ Yes No
Is this a residential or ommercial project? XResidential ❑ Commercial
If residential, is it: ASingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes rA No 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 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 #
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 ctx.v�dl�a ttcl�irc{i ignature Date