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HomeMy WebLinkAbout4816 Regency Dr - Applications/Furnace - 10/13/2016Oct 13 16 01:06p Swan Heating and Air 970-613-0826 p.1 0� Planning, Development & Transporiattion 281 N. College Ave P.Q_. Ilox 580 Fort Collins, CO 80524 Phone 970416 2740 Fax 224-6134 OVERaTHE,COUN'TEt PERMITS ONLY TMa QjqMftn 4a 4a 6o ueod to apply ivr thq tallowiing peanift only (cheok all that apply). r Conditioning [i o&lion (interior non -structure!) 0 Eteetrleai Alteration (not service change) i1 Gas Ughter 13 Gas Log eetin9 Un t 17 Lewd Sprinkler 13 Mobile Home replacement IJ Roofing CI Sewer tine LI Photo -voltaic ❑ VenflMdon Ci Wager Meater 0 Water tine © woodiftflet Stove (must be EPA certified, provide make, model and _ manufeotu*. Compfabia rill appttaabla information on thL%avolication. Incomplete avolleations will not be accepted. App►ir�ti®n �lJ _ c_� l Date i For office fm only g 1 too �D 1 R a 30 Site MOM rra vHIM0 Value of 0woftuction {tabor, matelials, profit) Property Owner lyafn Address Citfistat a Zip Phone &o -7 q `61 lea F06 %Z (.0 91-3Sq b r ADMIU E hame Ad&W city/state Zip Phone Contrdct or Address Gty/Stoat! Zip Phone q 7 Contra= City of Inns Sales Tar, # Are you paying tw= hem or by reiport? 0 Here a R,epoit SadertBxn Is.agr� byallaantracevx Are you paying whit year buff accounk? 13 Yes 13 No I5 this a residential or mpftfeMal project WRes101111a! 0 CwnmeTdal If residential, is it. Single family Detached U Condoftownhome (single family attached) Q Duplex O, Muliffamily (aparirnent:) El Garage If commercial, is It 0 Bank IS Bar 13 Chumb © Hotei114 Q Medical office: 13 office 13 Retail 17 Restaurant 0 Other (expl®in Is this budding 50 years of age or more? O Yes o Ifl'�rYoumByn�d il, mniactl�staricPr�senrdiicn If this is for a demolition permit, what year was the bullding corMuMd? If prior to 1975; Yoy W/V mead an asbca4 0s asPan men iio submit Uob5 b* appftbon. Description of ",If fawn sprialderJba"d preventer, must Ilst licensed plumber. if first,dme A14 must llst Ikemoed elecbidan. aubwntraoarx. Lbrifiecvmpanyn meorGtyofFtCbftzF v=# 9amlr 6n Plumber Mafianiea! Rode Other i hereby admowlerlge that s have read this application and sbte ftt the above information is =V)eta and correct I agree to . ®mp)y with ail regeliemen6 mntalrwd heMn and My ordinanoes and state laws regulating budding oocrMcdon. Y Imow t ltsta pemit Is not valid:unto it Ims been pald and issued. 0qn9bvV_1j11-Ap18Il®I1E: d