HomeMy WebLinkAbout1637 Greenstone Trl - Applications/Furnace - 02/18/2016;tanning, D-evelopment & Transp-ornr don
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970- 116-2740 Fax 224-61341
This plicatioi; is to be Used to apply for ule following per:nits only (check all that apply), ❑ Air Conditioning
0 Deindition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
//Hestin g Unit ❑ Lawn Sprinkler ❑ Nlobile Home replacement ❑ Roofing ❑ Seaver Line El Photo -voltaic
Ci Ventilation ❑ !Hater Heater ❑ Water Line ❑ Wood/Pellet Stogie (must be EPA cenfled, provide make, modal and
i11��r,�_uacturer).
nor: plate all ai plicabla irifori nation on the application. Incomplete applicatlons evil] not be accepted.
_ �U0o —1 Date
r'�plJlli-c UOfI rr ae .--_
For office use only
jo=o Sae A dtiras^ (r�gubod)
_
'Value of Construction (labor, materials, profit)
I Pl-operty Owner n e
Address
City/State Zip
Phone
01
Applicai t Nan e..
Address
City/state Zip
Phone
J��2:r,_, � !;,i 1'
1 d
9�� J _�• C �J'
qgzl=tlgGI1
Contractor-,
Address
City/State Zip
Pholn-,
Contractor City of Ft. Collins Sales Tax #
Are YOU paying taxes here or by report?
❑ Here `z"Report
limp,[101-jS/-e iliredb)laliaontractors.
Are you paying with your trust account?
'q.Yes ❑ No
.110 .r -L
Is this a residential or commercial project? Residential ❑ Commercial
1f residential; is it: >( Single Family Detached ❑ Condo/townhome (single family attached) ❑ DupleX
❑ I\lultifainily (apartment) ❑ Garage
1f commercial, is it: ❑ Banlc ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building -0 years of aga or more? El ❑ No Ifyes, you may need to contactliistoricPreservation
If tljis is for a eiez.l.o ition pent-jit, what year was the building constructed?
ff.pior to 1975, you
a,ill geed an asbestos assessment to subrlaiiti�vith this application.
Description of
'zff lawn sprinkler/backfiow preventer, must list licensed plurnber. If first-time A/C, must list licensed electrician.
si,'bco11t'aCtors: List1/70cot t2panynarneorCity ofFtCollins license r"
Plumber.
Mechanical Roofer _ Other
---- ppcomplete
r1.Ly aclulowledge that I have read this application and state that the above information is and correct. I agree to !
conipiy with all requirements contained herein and city ordinances and state laws regulating building construction. 3 lalotiv -that a
I:(:rillit is riot valid Undi it has been paidandissa;ec3.
Applicant: it � [�� Yr„Ir
Print Nanle:i.J.- .! .� V D =3 r'`( �a'.9 �'sgnarura, /'-J��i,)%�;?�,1 i� _ ✓�`�3xe -� -- - -- -