HomeMy WebLinkAbout3401 Riva Ridge Dr - Applications/Furnace - 10/20/201410-20-14;07:38AM; ;970-484-4448 # 4/ 15
Fort Collins
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-TH&COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
q Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Una ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Una 0 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 # Z i A-112S2 . Date
For office use only
Job Site Add I , (4 a, q��
Value of Construction (labor, materials, profit)
P rty Ow Name Address
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City/state Zip
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A pilcant
City/State Zip
Phone
jam 1Address
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ntractor Address
city/State Zip
Phone
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. M a $O4a
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?.
q Here ;keport
salwbxnumaerZ r Qu �ayarlmnaaMrS.
Are you paying with your trust account?1/
LYes 0 No
Is this a residential or
comerdal project? P!l Aesidential ❑ Commerclai
If residential, Is it: ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
(apartment) D Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Offlce ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building SO years of age or more? O Yes ❑ No Dyes, you may need to contact Htstodc Preservation
If this Is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wi// need an asbestos assessment to submit with this a /cabin.
Description of work
f i .
i
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or sty of Ft CON/ns license .4r
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 Name: , -rl Cri n
Date 1t0-a6-1 _`