HomeMy WebLinkAbout1605 Azalea Dr - Applications/Furnace - 11/25/2015From:
11/25/2015 09:05 #934 P.001/001
City of Planning, Development & Transportation
'Fort Collins Fort N. College Ave P.O. Box 580
-+�_ ` 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
VHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater Cl Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applic1, inprr rtn on the application. Incomplete applications will not be accepted.
Application # Date S.
For olfrce use only — ��—
Job Site Address (required) Value of Construction (labor, materials, profit)
1 DAP
Property Owner Name Address City/State Zip Phone
o3
a '� a?-54
Applicant Name Address City/State Zi
P Phone
Contractor Address City/State Zip
I % % , a A - P Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WrHere .Report
Sales tax number is required by all contractors Are you paying with your trust account? XYes El No
Is this a residential or commercial Project? (kesidential ❑ Commercial
If residential, is it: ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank CI Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbestos assessment to submit with this app/Icabon.
Description of work
*If lawn sprinkler/backRow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: list the company name or City of Collins license 4,
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 Name:,
tCcxQ„ &.1 \—\VVN Signature
Date