HomeMy WebLinkAbout3551 Pike Cir N - Applications/Furnace - 08/16/2017Plannft, Development & Transportation
281 N. College Ave P.O. Box 580
[tins Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This ap lication is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Dp iolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
seating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voRaic
CI 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 appilcatlons wi11 not be accepted
Application #
1�j 1 1. (7) All S Date 1&%
Foroffee use only
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Job Site A Address (rz9ulred) Value of Constucbon (labor, materials,
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3551 Xe �If` �� a sas�
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City/State ZIP Pnone
Property Owner Name Address
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Address City/State d Zlpp J V Phoon. ee
AppltcantNamea 105AI-1"�__
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Address City/State Zip
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Contractor ,,pp�"� 1�
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report7 ❑ Here Reporti
Are you Paying
v12s es� rrumberesrz7uheibyaUmntraclois with your trUSC account? Yes ❑ No
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Is this a residential 0& merdal project? f0,Residential ❑ Commercial
if residential, is It: - t�e;5 ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
[7 Multifamily (apartment) ❑ Garage
iP commercial, is it: ❑ Bank ❑Bar ❑Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ other (explain) maY need to rontactH/stpr/cPres>?rvadan
Is this building 50 years of age or morel 11 Yes ❑ No Ifyas you
If tills is for a demolition permit, what year was the building constructed?
If/ufvr to 1975, you will need an asbest'ns assessment to subm/t WM ift/e app/lcaU
I Description of work
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must Its? licensed plumber. If first-time A/C, must Its? licensed electrician.
'-IP lawn spdnkler/backFlow preventer,
Subcontractors: UstMe company name orCtyofF[ Gb/ues/lo°n� L other
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: Plumber M�1�1-- �o�
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I r 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 stale laws regulating building construction. i know that a
I permit is not valid until it has been paid and issued.
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Applicant.- n�y� 'Ian. . sl9nature �* - DL 1
i Print Name.. •'� 1 ,,—