HomeMy WebLinkAbout824 Powderhorn Dr - Applications/Other - 02/09/201602/01/2018 4:57PM FAX 9703527089 ACLEANSWEEP
IA0001/0001
�,City of Planning,1
281 N. Colle
ort 4ottins Fort Collins,
Phone 970J
OVER-THE-COUNTER PER
This application is to be used to apply for the following permits only (che
❑;Demolition (interior non-structural) ❑ Electrical Alteration (not service chap
01Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing
OVentilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be
manufacturer).
Complete all applicable information on the application. Incomplete appy
Application #
B1(000(011A
For office use only
Date
relopment & Transportation
Ave P.O. Box 580
180524
-2740 Fax 224--6134
ITS ONLY
:k all that apply). ❑ Air Conditioning
e) ❑ Gas Lighter ❑ Gas Log
❑ Sewer Line ❑ Photo -voltaic
=PA certified, provide make, model and
will not be accepted.
1-H, zlgSICP
Job Site Address (required)
Value of Co
istruckion (labor, materials, profit)
T214 Da.
4
3-I oo .
Property Owner Name Address
City/State
Zip
Phone
AN P'CoLUNS1Co
S"05'2('
910-;19-5311�
Applicant Name Address
City/State
Zip
Phone
ArbvlcNc eD �o 2'� �o ta3c,X ;2,-b-(-tin
1-10-33 `?- F3b$
Contractor Address
City/State
ZIP
Phone
AW milseb acn- i rt-w
Co
1m'tp33
010--33n - 836t
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes
here or by report?
❑ Here-Weport
Sales taxnumber isrequired byall conbacAws
are you paying with
our trust account?-IYes No
Is this a residential or commercial project? BlResidential ❑ Commercial
If residential, is it: 0 Single Family Detached ❑ Condo/townhome (single
Cl Multifamily (apartment) t7 Garage
If commercial, is it: 13 Bank ❑ Bar ❑ Church 13 Hotel/Motel ❑ Medical
❑ Restaurant ❑ Other (explaln)
Is this building 50 years of age or more? ❑ Yes 13No Dyes, you may ne
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 widr this appIn
Description of work V sit Avcisign E%tN i t N
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C,
Subcontractors: List the company name or City of Ft Collins //tense 9
Electrician Plumber_ Mechanical
I hereby acknowledge that I have read this application and state that the above ii
comply with all requirements contained herein and city ordinances and state laws
permit is not valid until it has been paid and issued.
Applicant: /n1.`
Print Name: vim'{ Signature,,,
attached) ❑ Duplex
❑ Office ❑ Retail
contact Historic Preservation
list licensed electrician.
Other
Is complete and correct. I agree to
building construction. I know that a
Date 2-1 1 1 1 6
WOOD EATER_ CERT-`
40,
The U.S. Environmental Protection A(Tejicv leas
determined, based on submitted information, that the
following wood heater model:
Hannan Stove
Modd Name
Absolute';
Model Number
1-ea—and Home Technologies — Hanna-
Manqfacuirer;'Vain-C
is certified as meeting the 1988 Standards of Performance for
New Residential Wood Heaters.
✓ Director
lvloniforin2. Assistance. and Media Programs Division
Eyf
6.. -1020*
... .......
-t Icate Number
Expiration Date
or dafe est- blished by regulation.