HomeMy WebLinkAbout3024 Ross Dr - Applications/Furnace - 09/26/2016SEP-21-2016 08:42AM FROM-
9704848354 T-273 P.004/013 F-317
ar�t CoU1ns
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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). 0 Air Conditioning
17 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn 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
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # T&0(-ow�o Pate q-uJ
For olilce use on/y
lob Site Address (requited)
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Value of Co truction (labor, materials, profit)
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P_mpertV Owner Name
EPA Ts s
Address
3Z
City/State Zip
Or. 13,ERANy7s, ,6
phone
6go 9l
Applicant Name
Address
city/state Zile
Phone
—Fort Collins Heating and Air
208 Commerce
Dr. 44 Fort Qllanq CO 805-24 (970
305-3478
Contractor
—Fort Collins Heating and Air
Address City/State Zip
208 Commerce Dr. #4 Fort Collins CO 80524 970
Phone
484-4552
Contractor City of Ft, Collins Sales Tax #
Sa/esawnum&risivquimdbyallconlractors
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? ❑ Yes
❑ Report
❑ No
Is this a residential or commercial project? *Residential El Commercial
If residential, is it: ❑ single Family Detached 41Condo/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 5o years of age or more? ❑ Yes E3 No if yes, you may need to contact Historic Preservation
If this is for a demolition, permit, what year was the building constructed?
if pvior to 1975, you wi// need an asbestos assessment to submit with this appllwiion.
DescdpWn.of work
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subootttractors; List the company name or City of Ft Coll/ns license #
Eleoridan Pluinber Mechanical H1309 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: Angela Morrow / / t�t�C/
Signature Date