HomeMy WebLinkAbout7427 Triangle Dr - Applications/Furnace - 06/30/2014Planning, Development & Transportation
,_,Ci'e1J oer"� 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
�.� Phone 970-416-2740 Fax 224-6134 \�a.
p� rip
®VET THE COUNTER PERM57S (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 # bI405rbe I Date
For office use only
Job Site Address (required)
2
Value of Construction (labor, materials, profit)
Aro - q-000
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
AireSery Fort Collins
City/State Zip
Phone
Contractor Fort Collins, r00524
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
sales tax number is required byall conhadors.
31'7 q
Are you paying taxes here or by report?
Are you paying with your trust account?
dHere ❑ Report
❑ Yes o
Is this a residential or coToiemial project? L>R!"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 mare? ❑Yes No ify4 you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
ifpnor to 1975, you will need an asbestos assessment to submit widr Mis application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List MecompanynameorCity OfFtCollinslicense#' \
Electrician Plumber Mechanical Roofer Other
1 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: (/ /a /
Print Name: -� Signa re l W Date c7