HomeMy WebLinkAbout433 Riva Ridge Dr - Applications/Furnace - 05/26/2017>/26/W76-201To99- 7AMAMFR gT
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lirt Collins
TO: 19702246134 FROI117 4QAT07234 T-494 P 005/0Qr F-4965
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). ❑ Air Conditioning
❑ 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
El 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 # R)M Ag S 3 Date ___ 5 Ia-(-f- n
For offide use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
4,61 o •
Property Owner Name IJ Address
City/State zip
Phone
NWut%*
RoA Or FhA CQIL%n%CO
S0,J25 Ckjo.Z016.
Applicant ame Address
Fort Wlins Heating and AjE 208 Commerce
City/State Zip
Dr- #4 Fort Collins, CO 80524
Phone
(970) 305-3478
Contractor Address
City/State Zip
Phone
Fort Collins Heatina and Air 208 Commerce Dr #4 Fort Collins CO 80524
970 484-4552
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by reporO
❑ Here ❑ Report
-Wes r"mffnberIsnwu*redbyall oiwov m
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or cogmercial prolecP EYResidential ❑ Commercial
If residential, is it: ®'Single Family Detached O Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church CJ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
13 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No tf yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the budding constructed?
If prior to 1975, you wW need an asbestos assessment to subm/t w th this application.
Descripbon of work
�If lawn sprinlder/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; List the company name or City of Ft Collins /rcense #
ElectnoarL. Plumber 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.
!� r
Applicant: ` / r/
Print Name An elaMorrow Signatur 'V `'"� r' ! ��l" Date
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