HomeMy WebLinkAbout2006 Amber Ct - Applications/Furnace - 01/08/2015A%
City Of
* . P•Ianning, Development tit'fr•olisp or'tntio11
f r" µ►oI pys 7f31 N, College Ave P.O. Box 58o
Fort Collins, Ct0 80524
Pholte 970-416-7,740 Fax 22�1.51:34
OVER-THE-COUNTER PERMITS ONLY
This ltplalica (irlieriol' non is t,1 he risoct to apply
q Dentolition (inifor• the following permits only (chrck all that apply), n Air Conelitionillg
�tltich.lral). CI Electllcal Alteration (not service change) CI Gas Lidhtt+r El [;as Lag
I� 1-leafing unit [I I_tivun 5pllttidcr q Mohile i-lonte 1.oplacxentent • D flooring Ll Sewer L.inc 1-1 Photo -voltaic
u Vcntcrrn Cl Weller Homier U Water line CJ VWod/
Ittanufach'tUPe-Ilet Slove (rnust be EPA e+cltiried„pro Vide Make, model and
n'o!).
Complete all tllipticabl0 irafnrfnlition on the application, incomplete applications will not be accopted,
ApPlication fir'•'' ��500a56
r-or or)Tcc Da l'e
701� Sil;e; Address (rcgcrlrer/1 ---
c 00 LP �
Property owl*'101.- NG)me —
Applicant IPlernca
Contractor
Contractor City. of t't,'�Co))ins•Sales Tax 9/.
5+tleshtl•rrur+7hr,�w'rr grrlrr?rlby,r/LrtryUDrh)rs
Value of constructiall (labor, mainrlals, plx,Qt)
Address rift'/5l�tte — —
Zip
Address
/ rlly/st,l;e 117
Address
City/Skate 71 p
Phone
Are yo1,1 paying taXCS here or by report? r7'Ftcrc, r-,,1 l;cpUrt
Are you paying with your trust ticcollnt7 [,-1 yes . LJ No
.Is this a residential or corrintel vial project? -,�cs]dr;ntial, q Contrncrcial ~� —
1(re:,idr-.I'rCial, is it:. 1!r;in9lc r-orr!)ly Detacitecl q Condo/[ownitonle (slnd)e family attached) Cl Duplex
[:! Multlfr•4mlly (apartment) • 0 Garage .
If rontlnr••rcial+ is il•; • q fran); n Bo -al' ❑ Church C7 I•lotel/Motel ❑Medical office ' D'Office [) f{et,�il
C Restaurant CJ Outer (explain)
is this buildir•Ig.Sp.yeat's of age or more? r:.'I yes ' 0 No —�—` "`—
If this is for a tl6itiCrlitioa peryttit, what year was thr, buprligg conatru(1I —
ys,) op r11c1Y heC�h to contBch //rslol/t: F'iY 3zvkr7lYUr1 )/ o1-iUr hq-t Y97.5; yclti �I ;'ll tl c'r+clan r7,pees(ns assesshlerrt (o s4Gglit.11,r(•h fhlr
Description of wol•I,
'If lawn ,prinkler/laaelcrlow prevenl:r..r, rnusl' list licertsad plum ael r. If first tirne A/C, nnisl: list lic:cnsc ~
5uAcontractot's: Gsl ll7C r ~� d ele.ct'rir,{,.qn —
ct? nranl nanle or rNk of /fi Cb//rns /icense
r^.lec[rieian,,,,—. _ ._—._ r�h•rn1l.,er _ _ yJy`/ ` /� :�
Rr,UFol' ..
— —. lather
Il"Wobya%knctwled r� —„—•, —,.— —., �_.--..--•--• ^
9: that; I halve read this appliGttion and slate that fhe above inforntal')on Is coutPlrf_-'�,� anti rorrr;•ct. I ac7ren, to
cimtply Will) all r cluirentents ronlallte <I 1lerraUl and City orthnanees and stale laws rn_yuratlny Luild;;tie Gort,flurlinlL know Clta'a
lK.rn,it is no1:'va[iri until. it; lt<s h+;en f>rald atld i_tsuc!d.
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