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HomeMy WebLinkAbout2715 Moore Ln - Applications/Furnace - 01/20/2014FROM :NCR FAX NO. :9702299903 San. 20 2013 04:55PM P3/4 Planning, Development & Transportation City of 281 N. College Ave P.O. Box 580 FQrt Collins Fort Collins, CO 80524 `.� Phone 970-41616-2740 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 © emolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log Heating Unit Q Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer line 0 Photo -voltaic ❑ Ventilation ❑ Water Heater CI 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 Ibe accepted. Application # �1400 241 Date I' 8u: `7 For office use only Job Site Address (required) -. Value of Construction (labor, materials, profit) Z 2 Uk"- q' cto Property Owner Name Address City/State Zip Phone ?0 3 - Applicant Name Address City/State Zip Phone Contractor ^Address City/state ZIP PhoneC1_)'0 k)nv�F4�yy)CAdz,X-y-,�r,c. gR2_ S Ave. P+CoN�t.'iLr� 2_ Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XReport Sales tax number is requiW by 6/1 ontmetmrs. Are you paying with your trust account? XYes ❑ No LP4'Lp_2- Is this a residential orrMsilultifamlly comenial project? Residential 17 Commercial If residential, is it: ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar 11 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (expla n) Is this building 50 years or age or more? ❑ Yes„ ANo Yyes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructe0 lfprior to 197.5, you will need an asbestos a&secsment 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 R Collins /!tense Pf Electrician___,,.,,,__,_ Number 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 Nam Date _ �—__e)[)'l