HomeMy WebLinkAbout2225 Ayrshire Dr - Applications/Furnace - 02/24/2016Planning, De;ae3opMen't B:Transpo.rtadon
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fix 224-6134
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
U Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
-leating Unit ❑ Laviin Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
III a11Ufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ��112n In q-1 D• Date
For ofrice use only
30h Site f`ddress (i2guirvd Value of Construction (labor, materials, profit)
&A4�_1iq9!5_1fLe6'bk- PT- 6athc, �e 0 5�- to
P•opel•ty Ow, er Name Address City/State Zip Phone
ty.Jip Ri�FiN 39511
Applicant Name.. Address City/State Zip Phone
Contractor r) Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here `-Report
y;J.; ea% nul?Oar isiequhedbyall contractors. Are you paying with your trust account? ' ,Yes ❑ No
Is this a residential or commercial project? residential El Commercial
if residential, is it: Ingle Family Deta ed ❑ Condo/townhome (single family attached) ❑ DlapleX
'❑ Muitifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a demolition pen-ri i, what year was the building constructed?
.Ifni%u- to 1975, you will need an asbestos assessment to sub ith this application.
n
I=
De- 1-*ption Of worn: Is
* f lawn sprinkie3 w preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companynaineorCity ofFtCollins license 'f
n_luctriaan_ Plumber Mechanical Roofer _ Other
r 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.
Print Namer�„
_91 t? iJ�3 vt r021 � �" 10 Signature_---