HomeMy WebLinkAbout2911 Zendt Dr - Applications/Furnace - 12/24/2014k
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Fort Colons
Planning, Development & Transportation
281 N. College Ave P,O, box 500
Fort Collins, CO 605211
Phone 970-416-274U Fax 224-61.34
- OVER-THE-COUNTER PERMITS. ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
17•Dernx�lition (interior iron-sb�rckurai) lO Electrical Pteration (not rervice change) U Gas Lighter ❑ GasLog
❑ Heating Unit ❑ Lavwn,33prini(ler CI Mobile Horne replacement .n Roofing ❑ Sewer Unc 0 Photo•voltsic
El Ventilation . Ll Water Heater • O Water tine ❑ Wood/Pellet Stove (must be. EPA cFrtifitmJ, provide make, model and
manufacturer).
Complete all add livable. information on th'e application. pncomplete applications will not be acceptod.
Applic@don #.., `�'I41,3oz-'
Date 145� rc�4-
1�)r ol5cm cso w77 ,
lob SiteyAddri:ss (9rmrrlirerf) -� V� Value of fpnstructiotj (labor, matrrials, profit)
Phone`/
l'ty OWner q Ime' A d' SS City/State
�
zip
rA2pplicantNarric , Address City/State
7-ig Phone
Contractor Address City/State 7_Ip Phone
Contractor City of Ft. -:Collins Sales Tax # • Are you paying taxes here or by report? 0 Here ❑ Report
Sale+staenuntG Is 0/m0*ir.1w:c. Are you paying with your trust account? ❑ Yes ❑ No
Is thl< a residential or c mcrchl project? esldential ❑ Corfirnercial
If residential, is it: • Siingle Family Detached ❑ Condoltownhomc (single family attached) ❑ Duplex
KL i 1U fan•diy (apartment) • ❑ Garoge .
If commercial, is it,- ❑ Bank ❑ Bar ❑ Church ❑ hiotellMotel ❑ Medical ofrice ❑ Office ❑ Retail
Restaurant ❑ Odier (explain) �,•.._�
Is this building ,,50.yeaes of age or more? 10 Yes .. 0 No 1l°yes, yriu n,ay need Po m!1(t7ci yis(DriC Prc� elw�h/op
If this is fora clOrliolition permit, what year was the building constructed:'—
!,°pry'v. to 19%, Moil I,,ill00W an d.SGCSGOS RS.WsSli7@p(' 1n sublpl( with this appll(ta6or)•
_.........
Description o(wol'kT��
:';If lawn sprinklerlb,ackrlow preventer, must list licensed plumber. If first-tlmc A/C, must list licensed electrician.
5ubcontraLtors: trshfhe mnlpvrp,na+>?e orci(yoFFCCtillins•licerue e
Electrician 'Pluinkr0r-- _ _ Mechanical / J� r Roofer _,- Other
I hereby acknowledge that I have read this application and state that tic above information is compiete and Correct. I agree to
comply with sill rr quiremenL- Contained herein and city ordinances and stale laws reguiating builrll,sg cur su u Lion, x lu�ow tlm$�n
permit is not vnli , until. it has been paid and issued.
Applicant: C`I / f`7Gf-�C�J r
Print Mama: �. r5 signaLurl#
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