HomeMy WebLinkAbout2225 Creekwood Dr - Applications/Furnace - 05/10/2016From 9702299983 1.970.229.9983 Tue May 10 14:49:17 2016 MDT Page 3 of 3
FROM :
FAX NO. : May 10 2016 08:47PM P3i3
Font Goltins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41.6-2740 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). Cl Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit 0 Lawn Sprinkler Q Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation ❑ Water Heater ❑ Water Line Cl 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 #-.. 2) � S! Q16 9 Date
For vffJre use only
lob Site Address Ovqulred)
2225. C lIKEKWOOD DR
Property Owner Name
DENNIS .PEDERSEN
Applicant Name
Value of Construction (labor, materials, profit)
$2 530,00
Address City/State Ziff Phone
Address Clty/State Zip Phone
Contractor Address City/State Zip Phone
NORTHERN COLORADO Alit, INC. 812 STOCKTON AVE FT COLLINS CO 80524 970-223-8873
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 'Ye
❑ Report
Sales tax number is requlmrd by all contractor% Are you paying with ypUr trust account? f � Yes 0 No
268fi2
Is this a residential or co mQrcial project? j"Residential ❑ 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
0 Restaurant ❑ Other (explain) _
Is this building 5o years of age or more? ❑ YesXNo If yes, you may need to cnntact"istaric Pheservat/on
If this is for demolition permit, what year was a building constructed?
If pr;or to 1975, you will need an asbestos assessment to submit w;th this application.
Description of work
---•---��'�'.P�,4r"�' �+,uu� � rr. a -- �— •---_
*If lawn sprinkler/backflow preventer, must list licensed plumber. If firstAlme A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician—,._ — Plumber_. Mechanir,�IT Roofer Other
I 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.
Applicant:
Print Name: `t/� 4 K�
TT. —�' _ .. �._�L— Signatu� Lkfj�l ... .= Date