HomeMy WebLinkAbout2630 Newgate Ct - Applications/Furnace - 04/17/2017I City ofCol.
ns
Plan ingr i?evelopment & Transportation
281 N.. College Ave P.D. Box 580
ForKollins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER,PERMITS ONLY
This application is to be used to apply for the foliorving pemrlts only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Aiteration (not service; change) ❑ Gas Lighter ❑ Gas Log
Bating Unit ❑ Lawn Sprinkler ❑ Moblle Home replacement ❑ Roofing O Sewer Line ❑ Photo-voftalc
❑ Ventilation ❑ Water Heater ❑ Water tine ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
mariufacturer).
Complete ill_applicable Information on the application. Incomplete applications will not be accepted.
Application # b 17 % Date << I 'I 1 f 17
For office use only
Job Site Address (raqu/red)
Value of CcnstrucUon Qabor, materlals, profit)
' 9Ll .va
00 Mw
(f
) ft5z
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Property Owner Name
Address
Ctty/Slate ZIP
Phone
Applicant Na
Address
C1ty/State Zip
Phone
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G�
d'
Cogtracbor
Address
City/State Zlp
o
Phone
',
Cojitiactor'CYty' of Ft CQlllns Sales Tax #
Are YP . PdYln9 taXRa here or by report?
Ar$you paying wittryobrtrust account?
❑Here ' Report
Wes Yes ❑ No
stri aumbPftriegrrk&byaumnceciws
Is this a reslderitial.or erdal pro)ect7 _ Residential 0 Commercial
if residentlal, is it: 13 Single Family Detached O Condo/tow_ nhoms (single family attached) ❑ Duplex
❑ Multifamiry (apart Trent) . ElGarage, '
If commercial, Is it: ❑ Bank ❑ gar. ❑ Church .Q Hobe_I/MoW ❑ Medical offlce ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years_ of age.or morel Cl Yes CINo if ye; you may need to contact HA-tolfcPreservadon
If this is fora demolition permit, what year was the building 0.r#mcted?
.rfpAor to 1975, YOU will neeo an asbestos assessment to subM1t WAh this eppOcadon.
Description of work
a:U lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must Ilst licensed electrician.
Subcontractors: L&Me company name oratyofRCbl/Ins//tense 0
Occiridan Plumber Medianital Rooter Other
f 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 Lssued.
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