HomeMy WebLinkAbout1648 Greenstone Trl - Applications/Furnace - 11/03/2017Planning, 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
❑ Healing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Une ❑ 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 #
�1'1a-ILA 04
For ofl7ca' use Dray
Date I 1- 3 14
Job 03 Add (regmy /
Il
Value of on (law,,�iaoeaialsI profit)
Owner Na Address
City/State Zip Phone
.
icant Name
City/State Phone
Sathi KcKiimey
Broomfield CO
Contractor Address
City/State Zip Phone
Coo er Reativa and Coolinst 11780
Oelmans Way 80020 _ 7 0-361-4245
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ene
tes
Saiestax nronberIsmgrdmdbya wntradxs
Are you paying with your trust account? rNo
Is this a residential or 96mmerdal project? ential O Commercial
If residential, is it: Single Family Deta ❑ Condo/townhome (single family attadW) ❑ Duplex
Iff Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank 138ar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail
O Restaurant ❑ Other (explain)
Is this building 50 Veers of age or more? O Yes O No if yes, you may need to wnfact Hzto c Presenrobhn
If this Is for a demolition permit, what year was the building constructed7
lfprior to 1975, Wu wi!/ fA d an asbestos assessment to submit with tbls app/kabom
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Suboontractors► List tine oampany name or sly of Coffin ikow 0
9ettridan Plumber Mechanical Roofs other
I hereby adnnowiedge 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 wdg It has bear paid and Imo.