HomeMy WebLinkAbout5106 Redbud Ct - Applications/Furnace - 05/26/2017From
05/26/2017 OB 03 0617 P 001/002
1
Planning, Development & Transportation
FCity of 281 N College Ave P.O. Box 580
ort Collins 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). it Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑Gas Lighter D Gas Log
*eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing O 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
oorrmmation on the application. Incomplete applications will not be accepted.
Application # '�/ I !�' IVDate fshQA)�
for oAice use only / 1
Job Site Address (required)
Value of Construction (la r, matenipls,,pr j t)
�_L�L11Phone1-il(ll
`/'11
Property Owner Name Address
City/State Zip
W �-7.S %� -
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? I rHere .Report
Sates tar number is required by a# con"c0s
Are you paying wikh your trust account? K Yes LI No
Is this a residential o1r �mmercial project? esidenbai ❑ Commercial
If residential, is atingle family Detach6d ❑Condo/townhome (single family attached) ❑Duplex
[[[]]] Multifamily (apartment) ❑ Garage
If commercial, Is it ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes O No If yes, you may need to contact H/storIc Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you wf// need an asbestos assessment to submit with this applicabon.
Descnption of
*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electrician
Subcontractors: List the company name or City of Ft Collins license 4
Electrician Plumber Mechanical 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 ` `'%.Cb\P -.:+,0 Signature. • .%,a, 6 • � Date