HomeMy WebLinkAbout812 Grandlake Ct - Applications/Furnace - 11/13/2014FROM :NCA
FAX NO. :9702299983 Nov. 13 2014 08:41AM P1/8
Application
Fort Corrins
Planning, Development & Transportation
281 N. College Ave P.O. Box 58o
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). 13 Air Conditioning
d Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing O Sewer Line 0 Photo -voltaic
Cl 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.
For Ofte use only
Date
Sob Site Address (re4 , )
Value of Construction (labor, materials, profit)
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a o-
Pro rty 4Prner Name Address
-
C
ty/State tip
Phone
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Applicant Name Address
City/State Zip
Phone
...........
Contractor Address
City/State P+COtkiinczip
Phone cT7' b
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ere
13 Report
Sales tax n'Q (-srep,4iredbya/lconb
Are you paying with your trust account?,�es
4 No,
Is this a residential or c mercial project? ,Residential ❑ Commercial
If residential, is it: Jff Single Family Detached ❑ Condo/townhome (single family attached) 13 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaJi �)
Is this building 60 years of age or more? O Yes jd No If yes, you may need to contact HIstMr/c Presermtlon
If this Is for a demolition permit, what year was th¢¢¢¢¢¢ building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this applicad'on.
Description of work
�If lawn sprinkler/hackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Cot/ins licrnse 0'
ElotMcisn Plumber Mechanical Roofer
C�T.Tdi
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 dty 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_ -�