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HomeMy WebLinkAbout2730 Jewelstone Ct - Applications/Furnace - 06/04/2014planning, Development & Transportation City, of 281 N. College Ave P.O. Box 580 FO1" CO«iIlS Fort cAlllns,co0050274.. Phone gins, 2Fax 2246134 OVER-THE-COUNTER PERMITS ONLY Z 5 2 This application is to be used to apply for the following permits only (check all that apply). 17 Air Conditioning d Demolition (interior norrstnictural) Q Electrical A teradon (not service change) ❑ Cos Ughter ❑ Gas Log ❑ Heating Unit ©Dawn Sprinkler O Mobile Home replacement ❑ Roofing O Sewer Une ❑ Photo voltaic ❑ Ventilation ❑ Water Heater U Water Une ❑ WoodlPellist Stove (must be EPA oertified, provide make, model and msnufscturer). Complete all applicable information on the application, incomplete applications will not be accepted. Application # f2�L4n2-l1L4 par once use odd' Applicant Name , Avu �7't%i�DB�mm�G Contractor 'Address /77 Lt Contractor City of Ft. Collins sales Tax # SQ1W tax avmaZ ,sAKm5bY all catoacexs. Date (0 Al - M Value of constructioy labor, materials, profit) Are you paying taxes here orby report? ❑ Here ❑ Report Are you paying with your trust account? ❑ Yes ❑ No Is this a residential ar. mercial project? tesidential ❑ Commercial If residential, Is It:. Ingle Family Detached Cl Condo/townhome (single family attached) ❑Duplex ❑ uldfamlly (apartment) ❑ Garage If commercial', Is ii: 'M 'Bank ❑ Bar ❑ Church O Hotel/Motel ❑ Medical office" A Office M Retall ❑ Restaurant ❑ Other (explpin) Is this building 6o.years of age or more? ❑ Yes Ma6lo Ifye4 you Mav deed to contact H/stone Ptmmatrbd If this Is for a derbolition permit, what year was the building constructed? If pnbr to 197s, yo4 hull need an asbestos assessmedt to s06dr2 With this $Ao/kat/on Description, of work 1 *If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed Subcontractors: Ust the cdhpadY naMe or CRk of Ft Collins llce/lse 0 Electrician plumber Mechanical �D 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 stawlaws regulating building construction. i know that a pernat is noty1a�li Until It has been pald and I=red. Applicant: `f�i'��i7�C� r Print Name? signatu Date �r