HomeMy WebLinkAbout5620 Fossil Creek Pkwy - Applications/Furnace - 07/14/2015RED LINE Heating & Coolin
970-613-1406 PA
r- t, �,= 281 N. College Ave P.O, Box 580
ram`'i`ter.: " Fort Collins, CO 80524
l y ` Ah ri ��.� J� J Phone 97G 416-2740 Fax 224-5134
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his application is to be used to �Nply for the follo.virtg ,�ernits orily (chec : e1i -that apply)- Q Air Conditioning
❑ Demolition (interior non-struciural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑Gas Log
D Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing G Sewer Line ❑ Photo -voltaic
❑ Ventilation Water Heater El �Arater Lina ❑ WoocfPellet Stove (must be EPA Ger l''led; provide make: model and
manufacturer).
vOmR6ere all gl7fJ11C3I3ie i Torl118iivP1. cn]ii0�ep?ilCsiio:,. I1COtels'i2:e arpiicatior's a+iii not beacCeeie .
Application
Date � l'--E 1'�` is
For office rise oRiy
k�=Y, aa�e o f Co;is icon (labor, matsiais, pro5t)
1 30o Sate �,dcress ,requited) .r
c55 Address CitylStabe Zip Phone
Property Owner Name r, _ , n n.: ..i ,�./L Grp c; ;S03 -`�7'4
Applicant Name
Address Cry/State
Contractor Address
Contractor Cry of Ft. Collins Sales Tax
Sell tpx number is required by all CO.-lbac,ars.
citylstate
3 L,TC 3
Zip Phone
Zip 'LJ � j Phone
Are you paying taxes here or by report? ❑ Here P- Report
' I
Are you paying with your trust account? Yes O No
Is this a residential or commercial project? 0-Residential m: Commercal
me (single family attached) ❑ puptoc
If residential, is it: ❑ single Family Detached
C Multifamily (apartment) 0 Garage
if commercial, is it. ❑ Bank i❑ Bar 0 Ghurch ❑ Hotel/Mote1 ❑Medical price ❑ OFce ❑ Reit
U Resmurant ❑ Other (explain)
is this building B5 years os age or more? ❑ Yes ❑ No _i yes, you nayneed to conractHis!'O c Prnser✓ation
If thisis for a s3e� +oii:ionrmEt, what year was the building constructed? irtatiar-
Irprior to ZS75, you rarili Reed an asbestos 2.ssyssment 0 Submit w,"tile ibis app
Cescription of vvork
"If lawn sprinkleribackflow preventer, must list Iiransed plumber. -if f lrsl ➢rne A.1C, mus, Ilsi llCenSed electrician,
gr;bcoritraceors: List the cnmpanyname ar C-)• OFF" Cclilns ficenss
Electidan� Plumber
Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above informa`ion Is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state la+vs regula5ng building conStrUCtiOn. 1 IGnow'Gifat a
permlY is notvalic? until it teas been paid and issues,.
ApPlIcant: Date
Prinz Marne:
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