HomeMy WebLinkAbout3526 Shallow Pond Dr - Applications/Furnace - 01/06/2014Frowl"oudre Valley Air
9704932073
01/06/2014 19:11 #749 P.001/001
City Of Planning, Development & Transportation
Collins
`
281 N. College Ave P.O. Box 580
FOr } ` Coll 1pp ns 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
`aieating 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 # 1!71It 0005A_ Date. J I ., to
For office rse only
Job Site Address (required)
Value of Construction (tabor, materials, profit)
�5
2
Property Owner Name Address
City/State Zip Phone
S
&&522 be tobl-Q
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ® Report
Sales tax number &leq&mdbyall cnntractors;
Are you paying with your trust account?.9Yes p No
Is this a residential or commercial project? Spesidential ❑ Commercial
If residential, is it: Dingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes O No Ifyes, you may need to contactHlstonc 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 appl/cadon.
Description of work
^ It lawn sprinMer/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins %rcense #
Elecb idan 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.
LA
Applicant: ^• /►
Print Name: ` \�C��Q Q_\Nw.% Signature Date A