HomeMy WebLinkAbout1937 W Plum St - Applications/Furnace - 01/20/2015Resend01-23-15;04;05PM; ;970-484-4448 # 4/ 10
City, of Planning. Development & Transportation
281 N. College Ave P.Q. Box 580
F<'rt Collins Fort Collins, CO 80524
r �r Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
11 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 13 Gas Lighter O Gas Lag
eating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement CI Roofing 0 Sewer Line 13 Photo -voltaic
Ventilation ❑ Water Heater 0 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 # T-3I Sbn taSI Date
Forofflce use only
Job Site Address (r /rFd) � � �
f
I W.0
Value of Construction pabor, materials, proRt) 00
t/..1'itn! - S
Property Owper Name Address
City/State Zip r Phone
Leh erg
el l
Applicant Nam Address
' 'n! 1 . L1 ti
City/state Zip Phone
�05 q7a• 8 • Pyl
Contractor• Address
Elm I /o f C. r
City/state Zlp Phone
P & 60 806015/ yd'N-- yB I
Contractor City of Ft. Collins Sales Tax *
Salestz rnamber/yD !
Are you paying taxes here or by report? O Here Pkepolt
Are trust
�byaffwnraepas,
you paying with your aocount? Yes d No
Is this a residential or commercial project? )Q Residential ❑ Commercial
I£residentlai, Is it: -,2F5ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church LJ Hotel/Motel 13 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes 0 No lfyes, you may need to ccn(actH1stoncPresnn don
If this Is for a demolitlon permit, what year was the building constructed?
Zfpnorto 1975 you w///need an asbestos assessment to subm/t w/th ffilsapplimbon.
Description of
lawn sprinkler/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llstthe cumpany name orGtyofFtcoll/nsl/cense #
Elecu4dan Plumber Medtanlcel Roofer. Other.
I hereby acknowiedge 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: rCXA-r)'Signature Date'
i.