HomeMy WebLinkAbout1201 Fairway Five Dr - Applications/Furnace - 11/17/2015From 9702299983 1.970.229.9983 Tue Nov 17 07:37:16 2015 MST Page 3 of.3
FROM FAX NO. Nov. 17 2015 02:35PM P3/3
City of Planning, Development & Transportation
F6�111�} ! pe1 281 N. College Ave P.O. Box 580
` Collins Fort Collins, CO 80524
/� Phone 970-416-2740 Fax 221-6134
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
/Heating Unit ❑ Lawn Sprinkler El 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 # s),ZE I q )
For ofPce use only
Date 11 —
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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rope Owner Name-Mv
Address City/state 60 zip
Phone
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Applicant NaMe
Address I Yity/State Zip
Phone
Contractor
Address City/state F}C0t11r1GZip
Phone 01""M
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nc . 21 Z� Co 9cr--, 2-4
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Mere ❑ Report
Sales tax nurrpberlsrequlredbyall contractors.
Are you paying with your trust account? es
13 No
jR ( 0-(( �
Is this a residential Or co mercial project? .6 Residential ❑ 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 ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building 5o years of age or more? ❑ Yes XNo Ifyes, youmayneed to contact HistorlcPreservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backFlow preventer, must list licensed plumber. If First-tlme A/C, must list licensed electrician.
Subcontractors: List the company name or Clty of Ff Collins license #
Electrician Plumber Mechanical hoofer
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 i9 not valid until it has been paid and Issued.
AppPrint iDate