HomeMy WebLinkAbout2155 Orchard Pl - Applications/Furnace - 07/14/2014 (2)City O
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Planning, Development & Transportation
281 N. Colle_e Av-= P.C. Sox 580
Fore Collins, CO 50524
Phone 0.70-416-2740 Fax 224-6134
16062�
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 Lag
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roaring ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stave (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # b-1 � 1) %- Date 7-/ZI-/2
For a5ce use only
Is this a residential or commercial projed7- [residential ❑ Commercial
If residential, Is it: ❑. Single Family Detached ElCando/townhome (single family attached) .❑ Duplex
,Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hatel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes Cl No Ifyes, you mayneed to con(actH/stiaHcPreservadon
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backFlaw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name Cr City eFt Co//ins license #
aectdci4BihPlumber 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.
Applicant:
Print Name: Signature Date
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