HomeMy WebLinkAbout2209 Loyola Ave - Applications/Furnace - 11/10/2015From 9702299983 1.970.229.9983 Tue Nov 10 15:08:21 2015 MST Page 1 of 5
FROM : FAX NO.
Nov. 10 2015 10:05PM P1/5
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 appllcation is to be used to apply for the following permits only (check all that apply). E3 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
/Heating 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 #j���a�� Date
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
/
Property Owner Na Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State }C ti(11VIC.Zip
Phone q7)Z
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Report
sriestax nurnberIsrequited byagmnnactors.
C9 (a(da
JKlere
Are you paying with your trust account? )RCYes
❑ No
Is this a residential or commercial project? Residential Ca Commercial
If residential,,,is it: l Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
[7 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explai )
Is this building 50 years of age or more? ❑ Yes JNo ,Tf yv5,you may need to contact HistorlcPreservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 19.75, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or crty ofR Coffins 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:
Print Nam
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