HomeMy WebLinkAbout330 E Pitkin St - Applications/Furnace - 08/25/2017`'rat Co�ljns 281N. '°a"d„` inc580 n
281 N. College Ave P.O. Boer 580
Fort Collns, (A 80524
Phone 970-416-2740 Fax 224.6134
OVER-THE-COUNTER PERMITS ONLY
11 Tiii oemamo�imenw o e Used to al" for the f UoMng poems only (dwk an that aPldy). o Air condlsonln9
( on -structural) O for
Alteration (not service change) O Gas Lighter O Gas Log
O Heating unit 13 Lawn SPrlyddcf p Aft fie 1101119 Mplawment ❑ Rodrig ❑ Sewer Lme ❑ p(p"ftft
n Ventilation 0 Water Heater t] Water Line
rrramdacturer). O Wood/Pellet Stove (must be EPA corded, provide make, model and
Complete all applicable Information on the application. Incomplete applications will not be accepted.
AMicati)n # EaC) S 3 SS - f LH nQ.P/ Date
Foradfkr roe a*
Job Adreas /'Whagf) value of consbuwon (labor, materials, prof)
30 Lj� � iou�s 3a3� sa
Property owner Name Address City/state zip
Phone
a_ r VJ i
Applicant Name
Address City/state 7Jp Plane
Address
Contractor
I . - n CIY/State ZIP Phone
Contractor City of Fri Collins Sales Tax A
S&WP,Ly1X1M&ff1FnV~AyaVom&aawm
Are You paying taxes here or by report? Here 17 Repot
Are you parAng with your trust amount? O Yes ❑ No
Is this a reside ftl or poled? Xl Go Gomnarcial
If residential, is it: Single Family Dotadred O Wndo/oormhome (single faintly attached) O Duplex
arage
If consnerdal, Is It: o Bank o Bar 0 C,aro, o° `oil
o Restaurant n Other Hobei/PNmel o Medical bffice ❑ olfioe a Retail
Is this building 50 yeas of ? (min)
if this Is for a demolition aDe a more. O Yes O No ermit, what year was the g con you tnayrrecd to CUM& H preservaalvn
,rfP*rto1975,yautv#/n�anasdestas es-werrfto thwiCr [sue
r_. ,,,, M.
*If lave sprinldw/baddbw Pam, must 4st licensed plum. If first bee AIC, must list licensed electriclan.
Sub,*,, ors. Lb! 64e cvmAsoyname or C8y oNR Lb///as //tensile #
Wumber F'W-r of
Roofer . Other
I herebY acknowledge that I have read this appiNation and state that the above information is complete and aired, I agree to
amply with all requinmerMs 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.
ApplkaM /
Print 4 signature bate 9,5- / �7
5237sd /�lGq t al.oy