HomeMy WebLinkAbout1508 Sea Wolf Ct - Applications/Furnace - 04/23/2012FROM :NCR
Fart Collins
FAX NO. :9702299983 Apr. 24 2011 11:47AM P1/3
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
0 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 # h I;,019; L) �- Date �- :12,:d- .
For ofT/ce use only r
]ob Site Address (required)
Property Owner Name Addrre,.ss
Applicant Name Address
Contractor Address
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by ail contactor
Value of Construction (labor, materials, profit)
Zip Phone
Zip Phone
City/State Zip Phone ci'to
Are you paying taxes here or by report? ❑ Here XReport
Are you paying with your trust account? I,Yes ❑ No
Is this a residential or commercial project? 9 Residential ❑ Commercial
If residential, Is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
9] Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant ❑Ocher (explai )
Is this building 50 years of age or more? ❑ Yes
If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year waste building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or CRY of Ft Collins license 0
Elemclan AA— -Q_ Plumber.,,_, Mechanlcak, 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 Nam
Gate �4 --Ls-f 7