HomeMy WebLinkAbout615 Monte Vista Ave - Applications/Furnace - 12/09/2011DEC-10-2011 15:48 From:Allen Service 970 484 4448 To:92246134
Page:8,�9
Planning, Development & Transportation
.City of 281 N. College'Ave P.O. Box 580
ort Colfins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
wo 1 ?
OVER-THE-COUNTER PERMITS RILY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) CI Gas lighter ❑ Gas Log
• Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing O Sewer Line O Photo -voltaic
• Ventilation XWater Heater O 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 # �� 2-101 Date
For office use ony
Job Site Address (required) //�� � Value of Construcdon (labor, materials, profit)
Owner Name Address
Applicant Name_ Address
City/State Zip Phone
a�7o60/5
City/State Zip Phone
Contractor Address City/State Zip Phone
�. Co 405. 1484/- q,9411
Contractor City of Ft. Collins Sales Tax ft Are you paying taxes here or by report? ❑ Here f(Report
Svies tax dumber is required by all contractors. Are you paying with your trust account? )K Yes O No
0 Z 1
Is this a residential or commercial project? IQ Residential Cl Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) . CI Duplex
4MuldFamily (apartment) ❑ Garage I
It commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes 0 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 -MCL'10 UP P. lT[.i577 wan - 11 QQ,fi.Q,�/ aj'1a'C i nSf"(Q)
*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 A'
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that 1 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. 1 know that a
permit is not valid until it has been paid and issued.
Applicant: bW"l
Print Name: SignaturQ�—