HomeMy WebLinkAbout4113 Beaver Creek Dr - Applications/Furnace - 10/08/2014City of , , k Planning, (Development & Transportation
p�Y :..,.; 2$1 N. College Ave P.O. Box 580
F®A t Collins t Fort Collins, CO 80524
BY. 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). ❑ 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 ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ 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 # 6H / 220 I Date 131 S 114
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip g t) 660 Phone q-? 0
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Applicant Name Address
City/State Zip Phone y 7 O
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Contractor Address
City/State Zip 805 3 � Phone 19-14-9
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Q Here ❑ Report
sales tax number is required by all contractors.
Are you paying with your trust account? 10 Yes ❑ No
53 Zto
Is this a residential or commercial project? Wesidential ❑ Commercial
If residential, is it: q Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
.1fpdor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacldiow 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 #
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: 1 y 4 D VJ e I L' 6- , t ((,� II� t J
Print Name: - Signature /� / - 1u l 4 Date C 8 / /
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