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HomeMy WebLinkAbout7126 Avondale Rd - Applications/Furnace - 10/28/2015Resendll-05-15;09:330 ; ;970-484-4448 a 5/ 9 c i t y oi_ti ollins Planning, Development & -transportation 281 N. College Ave P.O. Box 5B0 Fort Collins, CO 80524 Phone 970-416-2740 Fax 22+6134 GVER-THE,-00UINTER PERNTS ONLY This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning 13 nolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log eating Unit ElLawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltalc ❑ ventilation d Water Heater 0 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 # � �sb�6b72� Date / o - UL For office use only lob Site Addre (requfrzd) Value of Construction (labor, materials, profit) _r - Property Owl er Name Address City/state Zip Phone Applicant Nam Address City/State Zip Phone Contractor Address City/State Zip Phone r o r S• tirv;t L6 e, o YA:0; / X/fd/- Contractor City of Ft. Collins sales Tax # Are you paying taxes here or by report? ❑ Mere IXReport s:airsr2%numb.,risraqu1redbyall m,7iractors. Are you paying with your trust account? YYes 0 No Is this a residential or commercial project? Xtesldential © Commercial If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail ❑ Restaurant ❑ Other (explain) is this building so years of age or more? ❑ Yes ❑ No Peyes, you mayneedto conta&H1storfcPresermtfon If this is for a demolition permit, what year was the building constructed? If pdor to X975, you will n Py an asbestos assessment W submit with this application. Description of work U h=UF *If lawn sprinkler/backflow preventer, must Ilst licensed plumber. If first-time A/C, must list licensed electrician. Su bcontractors: ust the company name or aty of re Collins license # b:lodridan Plumber Mechanical Roofer Otller t 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. 0.0 Applicant: ��-a g-! Print NN ame,-9-TY- li O RI FfIIJ Signature ate u