HomeMy WebLinkAbout1825 Overlook Dr - Applications/Furnace - 07/27/2012From:Poudre Valley'Air 9704932073
07/27/2012 10:36 #712 P.001/001
Fort of
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). k
r Conditioning
❑ Demolition (interior non-structural) ❑Electrical Alteration (not service change) ❑ Gas LighterGas 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 # 131 ',-0C4 (I11 01
For office use only
Date I • V -1 Z
Job Site Address (requirpo)
ISZS 6v.ow1ootty
Value of Construction (labor, materials, profit)
11.00
Property Owner Name
JA4 PA v w
Address City/State Zip Phone
as abovit 6*(h W1& wis2. a z299,-i
Applicant Name
Address Gty/State Zip Phone
Contractor
Address City/State Zip Phone
a
Contractor City of Ft. Collins Sales Tax #
sales tax number is required by a#cw actors
Are you paying taxes here or by report? ❑ Here ® Report
Are you paying with your trust account? AYes a No
Is this a residential ommercial project? Residential ❑ Commercial
If residential; is It: M Single Family DetadW ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex lal
Is this building 50 years of age or more? 17 Yes 7.JN0 If yes, you mayneeed to contact HlsiorncPreservation
If this Is for a demolition permit, what year was the building constructed?
IfpAor to 1975, you Wff need an asbestos assessment to submit w/th this applrcabm
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 dry offs Cad/ns Anwse Jr
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this applkation 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: /1
Print Name:��CQ\e - G%L)DM Signature S�&L� Date
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