HomeMy WebLinkAbout1523 W Elizabeth St - Applications/Furnace - 04/11/2014FROM :NCR FAX NO. :9702299983 Mar. 11 2014 10:11AM P1/1
Planning, Development & Transportation rCity0�I
Fort Collins Fort N. College Ave P.O. Box 580 —
t Collins, CO 80524 �
Phone 970-416-2740 Fax 224-6134
M
OVER-THEMCOUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Pernolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation M Water Heater A 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 ac
c
epted:
Application # B 14 o I l o h Date'
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
*)
1
Property Owner Name
_
Y Address
{.^y' Zip
Phone
�Cityy/pSttatte
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/state Zip
Phone C1 _�a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here .Report
salesraxnumberrsrequiredbyalrconrrwWa.
Are you paying with your trust account?
[<Yes ❑ No
Is this a residential or commercial project? gResi ntial ❑ Commercial
If residential, is it: ❑ Single Family Detached Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (eYebuilding
-)
Is this building 50 years of age or more? ❑ Yeso If yes, you may need to contact Historic Proservation
If this is for a demolition permit, what year was constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backnow 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 #
Eledr:dan 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.
Applicant:
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