HomeMy WebLinkAbout512 Albion Way - Applications/Furnace - 12/02/2014Resendll-04-14;10:14AM; ;970-484-4448 # 19/ 20
/Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone §70-416-2740 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). O Air Conditioning
demolition
(Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
entilation ❑ 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 # b 141�n� Date / o — �� • o� • I `i"
For o9/cr use only
]ob Site Address (requlreo')
� Value o�nstl'uction Cla r,materials, profit) ot
514
Pro rty Name Address
city/State ZIP �aVg Phone
!gr
m
Applicant NaAddress
City/State Zip Phone
Icri •TJIN la t:5 . LIN
�� O• /
ntractor Address
City/State p Phone
en I lD / . 1
� �i O oa�!a y� g
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? _ Q Here Report
sa/ertax numberI r r dby0conftd=
Are you paying with your trust account? l;S Yes ❑ No
Is this a residential or mmercial project? 3tesidential ❑ Commercial
If residential, is it: .SIngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
4❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? CI Yes ❑ No Ifyes, you may need to contact Hlstor/c Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submit with thisappl[cadon.
Description of work
� _ 1 . a
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust Me company name or aty of Ft Collins 116ensa .0
pectridan Plumber Methankal 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:Cri"Wr"q
(V Signature
'Date _.: _./ O - oa—1