Loading...
HomeMy WebLinkAbout5227 Keystone Creek Ct - Applications/Furnace - 04/11/2014FROM :NCA FAX NO. :9702299983 Mar. 28 2014 10:53AM P2/3 City of. ort Collins 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 ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log Pf Heating unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic 13 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 # f3 14o n 15 Date 4 14 For offke use only lob Site Address (required) Value of Construction (labor, materials, profit) t7o! �5 _..... Property Owner Narnek Address City/State C, Zip Phone Applicant N Address �aty/State Zip Phone Contractor Address City/State 1.k%MZip Phone ©I'M r 6Lie-6 C. 21 Zs Go Rc 2- Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? )Mere ❑ Report r,r SeWt"aumberarequredbya#con crwr. 12 L 02!Lro a Are you paying with your trust account? �les ❑ No Is this a residential or commercial project? UrResidential O Commercial If residential, Is it: '(Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank O Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office - 13 Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes No Dyes, you may need to contact Historic Avservatlon If this is for a demolition permit, what year was thXebulldlng constructed? „ ...... If prior to 1975, you w111 need an asbestos assessment to submit with th/s application. Description of work *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 A' Col1Ms license 0 Electrician 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. Applicants print Nam Date 1