HomeMy WebLinkAbout1400 Beech Ct - Applications/Furnace - 09/13/2016From
09/13/2016 06:47 0334 P.001/001
fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 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):Wir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Gas Log
l9peating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation``&ater Heater ❑ Water Line ❑ 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 # JI A�� �J��-I , bhoO56D Date SJ\L��U
For ofce use only 4 kob 5 (0O I
lob Site Address (required)
Value of Construction (lab r, materials, profit)
95. g3
Property Owner Name Address
City/State Zip Phone
v
CO gL.
Applicant Nalik I Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
�
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere *Report
sales tax number rs required by all contractors
Are you paying with your trust account? X Yes El No
Is this a residential or commercial project? e.PResidential ❑ 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
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 0
Electrician Plumber Mechanical 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:' `�CD� �►� �� Signature ,.�� q. _ Date