HomeMy WebLinkAbout5214 Fox Hills Dr - Applications/Furnace - 04/18/2017Plamdn& Development a Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970.416-2740 Fax 224fi134
OVER-THE-COUNTER PERMITS ONLY
This application W to be used to apply for do following permits only (check an that apply). O Air Conditioning
O Demolition (interior nonq*ucWml) O Electrical Alteration (not service charge) O Gas Lighter O Gas Log
O Heating Unit O Lawn Sprinkler O Mobile Home replacement O Roofing O Sewer Line O Photo-volteic
13 Ventilation O Water Heater O Water Line O WoodlPellet'Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
APAlication # A/-),0a_142 Date 4/-/F-/ 7
for dffw rare only
lob Site Address (haw^d)
Vahne of Cambuetton (labor, mate, profit)
r
Fe 7LY • o d
Property Owner Name Address
aty/gate 23P Phone
Applicant Name Address
dty/state. DP Phone
Contractor Address
city/state ZIP Phone
--ZU-
Corthacior City of Collins sales Tax 9
f Are you paying taxes here or by report? )8( Here O Report
soresrr��rrma'*ff mq�edbyagmrbacfas:
Are you paying with your trust account? O Yes O No
Is this a reslderdial or commercial project? pAesidential O Commercial
If re iklential, is it: YSlngIeFamIlVDetached O Condo/townhome (single family alladied) O Duplex
Multifamily (apartment) O Garage
If eonnrrnerda1, is it: O Bank O Bar O Church O Hotel/Motel O Medical office O Office O Retail
O Restaurant D Other (Main)
Is this building 50 years of age or more? O Yes O No If yes, ynu may need to contact Hhft* PASS& abon
If this is for a demolition penni% what year was the building constructed?
Ifprkr to 1975, you wl// need an asbestos assessment to subrn/t *Yffi d* ap#AwM rr.
Desaiption of work
*If lawn sprinkler/baddbw prowenler, must Iist licensed plumber. If first-time A/C, must list licamed eLeotriciim.
Subowdraebms: Use Ghe company name or Qfy of R Caft s Ltwsae 0
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 Lss;
Applicant:
Print Nano: - signature 444 Dam /-/-IF-17
403.- 15S 3S 3,?G ,? 3 r-So �J/•ss,