HomeMy WebLinkAbout1301 E Stuart St - Applications/Furnace - 04/11/2014.City of Planning. Development & Tranaporta don
281 N. College Ave P.O. Boz S80
,or } ` CothnS Fort Collins, CO, B0524
Phone 970-416-2740 Fax 224-6134
OVEN-THEWCOUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (intedornonstructural) ❑ EleetricalAteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler El Mobile Home replacement ❑ Roofing . ❑ Sewer Line ❑ Photo-votaic
❑ Ventilation Cl Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA celfified, provide make, model and
manufacturer).
Complete all applicable infomniation-on the application. Incomplete applications will not be accepted.
Application # 714-00-1 Date
Rar off/oe um only
Sob Site Address (requred)
Value.o Constraotion (labor, materials, profit)
Property Owner Name ' Address
City/Stabe Zip Phone
YeDg/bocv /goi 'e- s Q r
: rc, c'o., O osr�99_ i�
Applicant Name Address City/Stale Zip Phone
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Contractor Address
City/Staff Zip Phone
Con tractor City of Ft Collins Sales Tax #
Are you payingtaxes here or by report? ❑ Here tilleport
Saves by is r ayd/cmtado-a.
Are you paying with your trust account?kjaes . ❑ No
Is this a residential or co mernal project? idential ❑ Commercial
If residential, is it 0.4ingle Family Detached ❑ Condo/townhome (single family attachid) . ❑ Duplex
❑ Multifamily (aparbwnt) ❑ Garage
If commercial, is it. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office Ca Office U Retail
❑ Restaurant ❑ Other (explain) _
Is thisbuilding 5Q years of age or more? ❑Yes t7' o If yes, you may need to con&rct;f'&&Vk rfCWv3bbn
If i:his is for a demo]Imn permit,.whatyea rwag the building constructed?
If pria- !0 1975, you will Wooden e9s,Gestrzs ass+�ment (n 5utmit wlby lh,� app/icat6n. T
Desscription of work _16;�Wla ill
*If lawn sprhkierJbackflow, preventer, rhUst 111tllcensdd plumber, if first-time A/C, must list Ilcenstd electriclan.
Subcontractors: Lw Oervmpanyname orCRY OfaCD10Wfkffiae# .2 d
Elecbiclen �a TJIca
Plumber��NcOq. Roofer_ qer
I hereby aclmcwkdge that I have read this appllratlon and state that the above information t5 ccmP' LMe and correct. I agree in comply with all requaernehts ccrltaiC W herein and city ol`dlnances and state' laws regulating bulldin§.cortsfructicn•. i' know that a
Permit Is not valid until It hag been paid and:lssued.
Applicant:
Print Name:. Signature. gate