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HomeMy WebLinkAbout2953 Teller Ct - Applications/Furnace - 12/09/2011DEC-10-2011 15:47 From:Allen Service City of �.Fort Coffins 970 484 4448 To:92246134 Pa9e:5/9 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 0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log )_4Heating Unit a Lawn Sprinkler ElMobile Home replacement Q Aoofing 0 Sewer Line ❑ Photo -voltaic Ventilation O 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 # Date For office use only _ Job Site Address (required) a.953 %/%, 61-. Value of Construction (labor, materials, profit) l=c cc) sas;� Property Owne Name Address city/State Zip Phone 4,bbr'� ArnP8 E-Lc. 5a/n� a o -- y5ao Applicant Name, Address City/State zip Phone Contractor Address City/State Zp Phone e- Cio 4o5,qqS,-/- qg Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report sdles bx number is required by all contractors. 1 C) Are you paying with your trust account? % Yes O No Is this a residential or commercial project? e:sidendal © Commercial If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) , ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it; ❑flank ❑ Bar O Church ❑ Hotel/Motel ❑ hledical office LO Office .0 Retail O Restaurant 0 Other (explain) Is this building 50 years of age or more? D Yes O 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 r *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 ofRCollins license 0 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. I know that a permit is not valid until it has been paid and issued. Applicant: h e fr I CA `( Print Name: Signatur Date