HomeMy WebLinkAbout3125 Kittery Ct - Applications/Furnace - 01/18/2012Planning, Development & Transportation
iCity Of 281 N. College Ave P10. Box 580
� Fort Collins, CO 80524
Phone 970-416.. 0 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). p Air. Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) .❑ Gas Lighter ❑ Gas Log
$,Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement. O Roofing ❑.Sewer Line ❑ Photo -voltaic
❑ 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.
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Foipfce use only
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Job Site Address (requlred) Value of Construction (labor, materials, profit) .
3 'L �rC • e_ �r ) 5 0 0
Property Owner Name Address City/State
Zip Phone
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97E-229-93J1 .
Applicant Name Address City/State"
I Zip Phone
Contractor Address City/State `
I Zip Phone
�-on nor 15.p. 411. aN
3.9-e9y-
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Contractor City of Ft. Col Ins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number Is required by all contractors.. Are you -paying with your trust account?. p Yes . . ❑ No
Is this a residential or commercial project? LVesidential ❑ Commercial
I.f residential, is it: �ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily(apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar . ❑`trhurch ❑ Hotel/Motel ❑'Medical office ❑ Office ❑Retail
❑. Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes XNo If yes, you may need to con6ct Historic Preservation
If this is for a deinolitionpermit, what year was the building constructed?
Ifprlor to 1975, you coil/need an asbestos assessment to submit with th/s.application.
Description of work Tom, NA%\ 60-6 q9a Ft
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list Iicensedelectrician.
Subcontractors: List the company name or Gty of Ft Collins license
Elecbidah_ _ Plumber Mechanical 44^ I #4 242 Roofer 1 Other
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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 knbw_that a
permit is not valid until it has been paid and, issued..
Applicant:' 1
Print Name: 11tY' Signature Date^�r�