HomeMy WebLinkAbout5118 Abbey Rd - Applications/Furnace - 12/09/2015From 9702299983 1.970.229.9983 Wed Dec 9 10:55:24 2015 MST Page 5 of 6
FROM FAX NO. Dec. 09 2015 05:53PM P5/6
City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Colirns Fort Collins, CO 80524
/1111 � 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
OJ7emoiition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
1Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
1y`
❑ 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 # F)1 51�Date
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
` c 1
�. SU 2-(,p a� -1
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State F{:A1WZip Phone Off
or+h ✓,��lcarrt� c, 21 Zs
Go gusL43-
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? -Mere ❑ Report
sales taxnunrb&-ISrequiredbya11cnntractora.
Are you paying with your trust account? es ❑ No
02192
Is this a residential or Commercial project? O'Residentlal ❑ 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
177 Restaurant ❑ Other (explain) _
Is this building 50 years of age or more? ❑ Yes b No If yes, you may need to contact Historic Preservatlon
If this is for a demolition permit, what year was the building constructed?
Tf 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-time A/C, must list licensed electrician.
Subcontractors: Llst the company name orG'tyofFtCollins license #
Electrician _
Mechanical Roofer
Other
I hereby ackhowledge 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
Date _- 0