HomeMy WebLinkAbout1021 S Lemay Ave - Applications/Furnace - 03/17/2014FROM :NCA FAX NO. :9702299983 May. 22 2014 02:02PM P4i4
t of Planning, Development & Transportatl
Cl
281 N. College Ave P.O. Box $81) ,,,r• "'':'::1
oft Collins 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
11pernolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line O 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.
Application # y �2 b I _ Date
For ofte use only
Job Site Address (required)
value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
Clty/State F-CttWkC-Zip
Phone 017)b
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? .Mere ❑ Report
Sales tax number Is requAWbyaiica tradars
Are you paying with your trust account? Xres
O No
Is this a residential or commercial project? ❑ Residential A Commercial
If residential', Is It: O Single Family Detached 0 Condo townhome (single family attached) ❑ Duplex
l7 Multifamily (apartment) 0 Garage
If commercial, Is It: 0 Bank 0 Bar 11 Church ❑ Hotel/Alotel 0 Medjcpl office O Office ❑ Retail
❑ Restaurant YT Other (explain) Cat_,C)W�Ir
Is this building 50 years of aye or more? ❑ yes ❑ No Ifyes, you may need lo contact HistoricPleservatlon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit Wt h this application.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins Acense 0
EleCtridan 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 j�� ���,,(
Print Name. Ifs na t p, s l&J—"'Slp Date