HomeMy WebLinkAbout4808 Chippendale Dr - Applications/Other - 01/26/2016Planning, Development & Transportation
281 N. College Ave P.O..3ox 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
2-COUNTER PERMITS ONLY
"his appli,:a t: is to be ;:s>ed to apply for the following permits only (check all that apply). ❑ Air Conditioning
Dr'��:rr;niit •:�r )1' '1011-'.!r'lir iur:tli ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
:d Heati't(j UTd C._ a..vn Fr.,:'inklf_>j ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Ling: ❑ Photo -voltaic
:0 �/�rltr;;lt::)r; ��;<.tc:l He,:r.�=r bliater LineIood/Pellet Stove (must be EPA certified, provide make, model and
rnanl;fa:::iurel:
Complete ail i :.)Ii,:al,Ie iiitorrnation on the application. Incomplete applications will not be accepted.
Application : � I � l� O. �Q.O � Date
mob Site 6i.ddi >:;s 1:::?r:irt %' Value of Construction (Libor, materials, profit)
Property OwnE Name Address City/State Zip Phone
if r, ,r
h I oly-ficla 1c, -b 01 FC" M.
applicant Pan,
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,.:or tr'ac':oi
Address City/State Zip Phone
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: (;':ra nc-a . CA)VIdaV t
U-30_1
Address City/State Zip Phone
- --—•---.._— '�, ���.33��$`l C��eeles�l C�J �fy� 33gnu-339 ���5
Contractor Cib, iF.. Collins Sales Tax # Are you paying taxes here or by report? )Here ❑ Report
.Sales n7v f)umber a^i : 2d by a,r contractors. Are you paying with your trust account? ❑ Yes AigNo
::s this a reside) .;I cr commercial project? Iikesiclential ❑ Commercial
'f residential, is t ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Mulrfamily (apartment) CI Garage
'f c.-Himierc V. ❑ Bar : Cl Bilr 1:3 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
l:ez: irn..tt Otlter (explain)
s t.tis b-:Jl( Ill): !j: ai s of = ge )r nor,.:' ❑ Yes ❑ No If yes, you[nay neerftocontact Historic Preservation
if this is for a c ..:to :lion p 'miit. vha,. year was the building constructed?
If /irinr to 1 :•%,,'l ;7e0., . , ft, ,;_'tits )s assessment to submit with this application.
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"if liavnt sprinkk "oao flaw pr°venter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractor- L%>,' tho c:'vi �.?panv name or i:ily of Ft Collins license �
Mechanical ... Roofer ...... e
-- - . ..........._._._. ............ - Other -......--._...._.....
1 here.by ac ;nov. :;t: thot I Iiavi:: ;.sac: thin, application and state that the above information is complete and correct. I agree to
conoly itlt tll 1 ;!;:irr-:nents a nta;r ed herein and city ordinances and state laws regulating building amstruction. I know that a
permit is not v:.I.d until it has been paid and issued.
i
Applicant:
Print Name-: ......... Signature
Date 1- 2 � -1
WOOD HEATER CERI'iwY���:I ON
i
This Cerfiricate is issued I'll 1'ecola nilltion th.'at
I
the follow*lng wood heater model Iline:
J
IMI. Vornon F2'
Alodel Name
f learth and Home Technologies
Alan 11file'turer -Nutne
has completed all requirements necessary fol-
v
certification and is a. certified model line pursuant to
U.S. Environmental Protection Agency regulations.
Director
Monitoring, Assistance, and -Media Pro. -rams Division
9 21, 0 1
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Certificate Number Evpirndon Vate