HomeMy WebLinkAbout621 Stoneham Ct - Applications/Furnace - 09/24/2015Resendl0-20-15;04:17PM; ;970-484-4448 # 8/ 12
C I ty 01
�Pon Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224.6134
OVER-THI rl 00UNTER 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
eating Unit CI Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
rJ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manidacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted,
Application 41. 121
02 U
For ofce use only
Date `9 —L—Zmj�
Job SitJ e Address (�qu�
n O VdIUOaIJOI� e of etion (later, materials, profit)
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Property er Name e
Address
Clty/State ZIP In Phone jWV
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Applican Nam9j
&crri il-Kn
Address
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City/state Zip Ph ne
A.N. rec,o WOW 1-0-LIN-YO/11
Contractor
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Address
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City/State Zip Phone
drv. ���a�11
Contractor City of Ft. Collins Sales Tax #
Are you paying Was here or by report? CO Here Report
Sa/ea tva% uumberlsrequlre+ibya// contractors.
Are you paying with your trust account? V Yes ❑ No
Is this a residential or commercial project? r❑ esidential El
If residential, is It: ,y��CIngle Family Detached C3 Condo/townhome (single family attached) Duplex
❑ Multlfamily (apartment) M Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Q Medical office C7 Office ❑ Retzll
❑ Restaurant ❑ Other (explain)
Is this building so years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact HISCONcPreservatlon
If this is for a demolition permit, what year was the building constructed?
If pifor to 1975, you avlll, ad an asbestos assessment to sub%w1b5 tb/s appllcatlon.
Description
—�•-• — —
*Ir lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: Llstmecompany name oralyofPCCo1=11cense#
E16cbic0n 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:
Print Name] wr t 0 R 1 FfA' J Signature ate —1