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HomeMy WebLinkAbout4002 Celtic Ln - Applications/Furnace - 02/10/2015Resend02-07-15;01:44PM; ;970-484-4448 # 2/ 11 Fort Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 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 (chock all that apply). ❑ Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Q Gas Log eating 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 # For office use only Date - ov_ 10 - l:� lob Site Add ss (requ/red) Value of Construction (labor, materials, profit) yDb XD .3511fr Property Owner Na Address Clty/State Zip Phone o �a.5"8�7 Applicant Nam Sherri i i(1 ID 1' Address �. 4%tiJ City/State Zip N. FL Co �O�aY Phone 4YO-g9q- g9g1 Contractor Address City/State Zip Phone o 5. 64N4 4N • o F'PJ'g wi( 'let Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report WesraxnumberIsrequiredbyallcnnaaetnns �oa�n Are you paying with your trust account? '%Yes ❑ No Is this a residential or commercial project? PResidendal ❑ Commercial If residential, Is it: Single Family Detac ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) Cl Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel El Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? © Yes ❑ No Ifyes, you mayneed to contactH&WlicPreservat/on If this is for a demolition permit, what year was the building constructed? Ifprior to 1975, you wit/Wol an asbestos assessment to submit rah this application. *If lawn sprinkler/backt1ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name ar Gty 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: (/�� ' v —r q Print Name. er rt C RI FF1tJ Signature s ' ate +�'