HomeMy WebLinkAbout500 Goldeneye Dr - Applications/Furnace - 06/17/2016I nnirij, ,D-evelopinnent u T.ransp0.rt�t`ion
1 ' 281 N. College Ave P.O. BoX 580
: K Fort Collins, CO 80524
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is -,51 piicadcm is to b used to apply nor tine EOilowing per; -:its only (check all that apply). ❑ Air Conditioning
D,=ni181itiorl (interior non-struct! Iral) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Ell Gas Log
�ing Unit. ❑ Lawn Sprinkle.-- ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
1 Vent iaiioi I !-7 Water f leater ❑ Water Line 1-1 Wood/Pellet Stove (Must be EPA certified, provide rnai<e, modal and
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'Conno to c it. j]i iiCZlJI? iniornation on the application, iricoi Plate aPPli�cations Will ilot be aCC2pl8il.
1_ Date 1!f=IQ-/ i
r,pplic l I:ion .,t—�-1�-� -
F.�r of ice use only
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a ;1 `3rass (i�c7ciii�d) Vzflua ,o Oonstriictaon (labor, materials, profit)
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Owner a Address
City/State Zip Phone
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or City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
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rac7uir dt Walt anGactois,
Are you paying with your trust account?
'Yes ❑ "I
IIs this a residential or commercial project? Residential L7 Commercial
—Iff reside itial, is it: Single Family Detac d ❑ Condo/tovinhome (single family attached) ❑ Duplex
El Multir"an-lily (apartment) ❑ Garage
1!' con-ini .rcial, is it: ❑ Bank ❑ Bar ❑ Church ❑ i iotel/Motel ❑ Medical office ❑ Office ❑ Retail
Cl Restaurant Cl Other (explain)
is this Wilding 50 years of ale or more? ❑ Yes ❑ Nlo If yes, youmaynearl to contact HistoricPi-eseruation
if this is for a den of Yical porn -flu :, what year was the building constructed?
_f,viiol- M 1:75, yOU I•vii/ ne d an asbestos assessment to submit with UV5 oplication.
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5nrinlder/backflow preventer, muss: list licensed plumber. If first -tune A/C, must list licensed electrician.
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actors: List!/?& company name or City of Ft Collinslic4nse
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Pltiml7er _-.. fNechanica!—------- Roofer Otlicr
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acknowledge that I have read this application and state that the above information is complete and correct. 1 agree to
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all requirements contained herein and city ordinances and state laws regulating building conSl'ructiGin, 1 i.nc1;v tIIaf u
not valid u n'_l; it ,gas been parry aa� l ;ssew�.
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