HomeMy WebLinkAbout1136 E Stuart St - Applications/Furnace - 03/16/2012-FROM :NCA
FAX NO. :9702299983 - Mar. 17 2011 03:07PM P2/2
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
❑ 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 #1 p y-tLis Date -„
For office use only
Job Site Address (required) Value of Construction (labor, materials, proflt)
Property Owner Name Address City/State Zip Phone
12S QC)i ii% 12 t/EkJ2t zoc� 1J1
Applicant Name Address Clty/ Late Zip Phone
Contractor Address 1 City/State Zip Phone Cif
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
safes tax nu^mber IsprequIredbyall contracmrs. Are you paying with your trust account? VYes ❑ No
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 A.
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Cy medical office CI Office ❑ Retail
❑ Restaurant ❑ Other (explain) _
Is this building 50 years of age or morel ❑ YesNo If yes, you may need to contact Historic Preservation
a bu
If this Is for a demolition permit, what year was ilding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work i'-! ()tig CQ L. 4"A AA knacin 1 i' 41 t T e r 7 * a H
F--E
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: LiDst the company name or City of Ft Collins license f
Elecoldan V�J��"� Plumber Mechanical Rooter 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 constriction. I know that a
permit is not valid until It has been paid and issued.
Applicants
Print Nam
Date S `l lP I Z