HomeMy WebLinkAbout5930 Falling Water Dr - Applications/Furnace - 07/21/2014FROM :NCR
FAX NO. :9702299983 Jul. 21 2014 10:29AM P4/5
oft 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
0}�emolitlon (interior non-structural) ❑ Electrical Alteration (n ot service change) ❑Gas Lights s❑Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement d Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation Water Heater E3Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
cturer
manufa)
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
far otike use only
job Site Address (Mulred)
Date"
Value of Construction (labor, materials, profit) .
Property Owner Name Address city/5t It,zip Phone
Applicant Name J Address VCity/State ZIP Phone
Contractor Address City/State F -Dililke-zip Phone CT. 'p
i�) r+ In ( (a✓tt. e itc. Ri is ko h Aft` co 4tf�- 2A a315
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? _Mere ❑ Report
sa/estax number amgt mdbyaBeonMactm• Are you paying with your trust account?' es ❑ No
—.Q U&C620Q -
Is this a residential or co mercial project? Residential E3 Commercial
If residential, Is it: Single Family Detached 0 Condo/townhome (single family attached) E3Duplex
Multifamiy (apartment) ❑ Garage
If commercial, is It: 0 Bank E3 Bar ❑ Church ❑ Hotel/Motel O Medical office ❑ Office [3 Retail
O Restaurant ❑ Other (expiai )
Is this building so years of age or more? D Yes XNo if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this applim0n.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or ply ofR Coll/ns license 0
klecvldan _ 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. I
Applicanti
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