HomeMy WebLinkAbout2919 Alamo Ave - Applications/Furnace - 10/14/2014FROM :NCA
FAX NO. :9702299983 Oct. 14 2014 02:01PM P3/9
of
Flirt Collins
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
❑ emolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
IHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 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 # U1—i J 09br} Date `1 I�'� (4
For afce use only
Job SiteAddress(required)
Value of Construction (labor, materials, profit)
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P perty Owner Name
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Address
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City/State Zip
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Phone
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Applicant Name
Address
City/state Zip
Phone
Contractor
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Contractor City of Ft. Collins Sales
Tax S
Are you paying taxes here or by report?
❑ Report
Sal&$tax nunr0erisrequ/reddy 0contractors
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Are you paying with your trust account? es
❑ No
Is this a residential or cg mercial project? OResidential ❑ Commerdal
If residential, Is it: .4 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 (cxpia n)
Is this building 50 years of ape or more? ❑ Yes No Ifyes, you may need to contact lyistoric Preservation
If this is for a demolition permit, what year was the building constructed?
If prlor to 1975, you will naed an asbestos assessment to submit with th/s applicadon.
Description of work
*If lawn sprinklerlbackfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: List the company name or City of Ft Collins ilmnse #
Elecbidan Plumber 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 Nam
Date 10`( " /
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