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HomeMy WebLinkAbout2119 Creekwood Dr - Applications/Furnace - 09/24/2014FROM :NCR FAX NO. :9702299983 Sep. 24 2014 0e:27AM P3i9 Fort 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 ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log Heating.Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line El Photo -voltaic Ventilation ❑ Water Heater A 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 # 'g14-0 VL9 S2— . Date c ...`"'f� �1 For office use only Job Site Address (required) Value of Construction (labor, materials, profit) OkL VA�.�Rc5 — _ Property Owner Name Address City/State ( Zip Phone 2c�-P✓S Applicant Name Address City/State Zip Phone Contractor Address City/State FA-Cf]WxQlp Phone 'o-Y 61:kv Ave Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report Sales Lax number isrrqulmdbyall mnmtm v. Are you paying with your trust account? X(es ❑ No Is this a residential or co merGal project? Residential ❑ Commercial If residential, is It. Single Family Detached 13 Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) IJ Garage If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office I] Office 0 Retail ❑ Restaurant ❑ Other (explal ) Is this building 50 years of age or more? El No If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was C building constructed? If prior to 1975, you will need an asbestos assessment to submit with this applleation. Description of work *If lawn sprinkler/backffow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license 4 Electrician 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 { "'