HomeMy WebLinkAbout3133 Grand Teton Pl - Applications/Furnace - 01/16/2015From:
01/16/2015 09:55 #521 P.001/001
Cit O>t FortPlanning, Development & Transportation
fort Coll!
For N. College Ave P.O. Box 580
�' ` �`.- Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER -THE -COULTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
CI Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
iZHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑.Hoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomple e-applications will not be accepted.
Application # P 1600231 Date
For ofte use only -
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State
Zip Phone
Applicant Name Address v
Gty/State Zip Phone
Contractor Address City/State Zi
1 k .. %% A P Phone
~ t
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere Report
"es tax number isrequirbyalJmntractws Are you paying with your trust account? KYes IQ No
Is this a residential or commercial project? residential ❑ Commercial
If residential; is it: mgle 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 more? ❑ Yes ❑ No If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Afpr/or to 1975, you wl// need an asbestos assessment to submit with this appbcatron.
Description of
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the company name or G'ty of Ft Collins license fi
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: h
Print Name: \UAP Signature _ l
Date �-