HomeMy WebLinkAbout736 Larkbunting Dr - Applications/Furnace - 12/11/2013Frow Poudre Valley Air 9704932073 12/11/2013 12:37 #704 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
eating 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 # ;q/.3ff0?K Date
For office use only
Job Site Address (required)
Value of Constructln (labor, materials, profit)
o� 0
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
AftVJ
-
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
K Report
Safes tax mumberisrequlredbyall contmaorx
Are you paying with your trust account? 'K Yes
❑No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is It: ❑ 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 ❑ No If yes, you may need t6 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 appikation.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or C7ty of Coffins 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:_ C\,y �R_ aeQ\M Signature Q y lza _ paw '