HomeMy WebLinkAbout6454 Edgeware St - Applications/Furnace - 01/23/2012Cityof Planning, Development & Transportation
Fr} 281 N. College Ave P.O. Box 580
�r ` 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
❑ Demolition (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 ❑ 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 # 'Ll ���53 _ _ Date 1/43 /Zo 12
For office use only
E454
ob Site Address (required) Value of Construction (labor, materials, profit)
E-PiCiEWhRE U. 11300. t%
Property Owner Name
Address
City/State Zip
Phone
(0959
DOGEDOGEWAkE
F7 cotLiusl805 5
5
-29
Applicant Name
Address
City/State Zip
Phone
Contractor Lic #
Address
City/State Zip
Phone
-07 I-
z��7zpn.
- 1%52
� 2 aEwFT. �
29
-74W
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here
❑ Report
Sales tax number is required by allcon&adors.
Are you paying with your trust account?
❑ Yes
❑ No
3i25y
Is this a residential or commercial project? ❑ Residential ❑ 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 (explain
Is this building 50 years of age or more? ❑ YesOr-No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If plior to 1975, you will need an asbestos assessment to submit with this application.
*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 Ft Collins license #
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.
Applicant: Print Name: M lE WET41�&RCIEV, ��,
Signature � G1-,Date