HomeMy WebLinkAbout1536 Birmingham Dr - Applications/Furnace - 05/20/2015Resend06-05-15;03;42PM; ;970-484-4448 # 2/ 13
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 (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
-treating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
O 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 accootod.
Application # E)150 H 6 S�_ — Date ,-:5=
Far office use only
Job Site Add ss (required)
Value of Construction (labor, materials, profit)
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Pro erty Owner Nam Addres
City/State
Zip
Phone
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Applicant Nam Addr
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City/State
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Zip
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Phone
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Address
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City/State
Zip
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Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here Report
Sales wxnumberisrequivdbyall contractws
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Are you paying with your trust account? ' .Yes ❑ No
Is this a residential or commercial project?-Resldential ❑ Commercial
If residential, is it: 1&ngle Family Deta ed ❑ Condo/townhome (single family attached) a Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? II Yes Cl No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If plior to 1975, you will iWd an asbestos assessment to submltAth this application.
Description of
*If lawn sprinkler/backtiow preventer, must list licensed plumber. If first-time AIC, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft CbIl/ns license #
EleCirlelan� Plumber
Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above informadon 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: ao�
Print Name. A4W.teit Q1 FOnJ Signature