HomeMy WebLinkAbout2909 Brumbaugh Dr - Applications/Furnace - 02/09/2012FROM :NCA
FAX NO. :9702299983 Feb. 09 2011 02:54PM P4/4
Fort 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 .
❑ pemolition (interior non-structural) C_l 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 # D i a j?) ((.-i-�
For ofce use only
Date 9 ` I - 1 a
Job Site Address (required)
Value of Construction (labor, materials, profit)
o . 0Z)
Property Owner Name
Address City/State Zip g(�.5
Phone
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Applicant Name
Address City/State Zip
Phone
Contractor
Address Cl y/State Zip
Phone G i'n
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✓i In4 ✓ YlC . Q J ALle— c o I 1 v Lo Stn L
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
XReport
Sales tax number is required byn#contractors.
Are you paying with your.trust account? KYes
❑ No
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Is this a residential or gfnmercial project? fZl Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 11 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? ❑ Yes )No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975r you will need an asbestos assessment to submit with this 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 Ft Collins license #
Electrician /1_-� 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 riot valid until it has been paid and issued.
Applicant:
Print Nam
Date