HomeMy WebLinkAbout4632 Brenton Dr - Applications/Furnace - 12/20/20171 i
plannlAq, E3eveloprnent & Transporta don
_ l t f,G or 281 N. College Ave P.O. Box 580
IM•rjA ,Alin s Fort Collins, -CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This ap iication is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
0 D iolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
seating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ 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 ontheapplication. Incomplete applications will Datenot be accepted
I�yA ( _
Application COLA
# -
ForoflSce use only
Sob Site Address (inquired)
Halve of ccinstmcbon (labor,/materials, profit)
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i) 7`• �-" co F , hJ
Proprerty Owner Name
LYle
Address
city/State Zip Phone
t� f,>, el
Address �
Zip Phone
ZCity/state
Applicant Names
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Contradol-01
Address
City/State Zip Phone
PA Akr
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ HereRzl
Are you paying with your trust account? 7-Yes ❑ No
::; ; c+� number�sraqurred by all ronbacfors
is this a residential or commercial protect? _2 Residential ❑ Commercial
If residential, is it' 59•5ingie Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
if commercial, is it. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
is this building So years of age or more? ❑ Yes ❑ No Ifyes, youmayneed to mntaclHistorlcPreservation
If Uvs is for a demolition permit, what year was the building constructed?
rfE nor to 1975, you will need an asbestos assessment to submit with this apP/ica60n.
i Description of work
'•if lawn spnnider/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:Gstthe companyname orLityofFtColhnshcense:f
Mechanical Roorer Other
Plumber -
i
1 t hereby acknowledge that I have read this application and state that the above information is complete and correct I agree rA I
comply with all i equtrements 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.
I Applicant: L� I'
Applic SlgnI