HomeMy WebLinkAbout537 Goldeneye Dr - Applications/Furnace - 12/10/2011DEC-10-2011 15:47 From:Allen Service
City of
�.Fort Collins
970 484 4448 To:92246134 Page:4,9
Punning, 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). 0 Air Conditioning
O Demolition (interior non-structural) O Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
eating Unit 0 Lawn Sprinkler O Mobile Home replacement C3 Roofing ❑ Sewer Line ❑ Photo -voltaic
,rI entilation O Water Heater Q Water Line O 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 # /bu t im Date /a - /D- /%
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
6S2 ( r" �Jj
N.
Property Owner Name Address City/State Zip Phone
/lieen F'f7, PigrR ilex f) LIZ (0-1 � a3- 53 r
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
471
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? O Here Report
Sales tax number a required by al/ contractors Are you paying with your trust account? )( Yes O No
Is this a residential or c mmercial project? .KResldendal ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) O Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church C7 Hotel/Motel O Medical office ❑ Office ❑ Retail
O Restaurant O Other (explain)
Is this building 50 years of age or more? ❑ Yes O No If yws you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 197S, you will need an asbestos assessment to ,submit with this application.
Description of work 1'\,P_MA U Q e tLl s " naI 711 r n A a_A_W to
*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 0
Electrician, Plumber
Mechanical Roofer
Other
l 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. Signatur Date/ ��d �l'`