HomeMy WebLinkAbout3913 Asbury Dr - Applications/Furnace - 12/29/2017Jan 0518 11 52a
F'6rt Collide
9706198074 p.4
Planning, 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). O Air Conditioning
❑ Demolition (interior non-structurao ❑ Electrical Alteration (not service change) 0 Gas Lighter 13 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 17 Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line ❑ 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 # b \ T 001-1
f,�raffia? use only
Date i 1
Sob Site Address (rrqu/ned)
value of Construction (labor, materials, profit)
>4c--)�)u DY' Fi- Coll InS C0 SOSO& f 5 � ,&3
Property Owner Name Address City/state Zip Phone
T1roWU rn M l�fyuti A 301 A-5)0f) DC FO(t CN I M S CD 05ab
Applicant Name \Address
9V )-Ehu2y-
City/State
State �? zip Phone q 7a
A y-c,
Contractor Address
Gty/State Zip 5963 :f Phone 9'70
Contractor Gty of Ft. Collin,. Sales Tax
OKA -
.��%[a�rnumberisrequbadbya#con&actors
�3 2r10
Are you paying taxes here or by report? O Here ❑Report
Are You Paying with your trust account? p Yes ❑ No
Is this a residential or commercial project? tZ Residential ❑ Commercial
If residential, is it: P Single Family Detached ❑ Condo/mvynhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hatt/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 13 Yes p No Ifyes, you mayrteed m cantactiiisfnric p
If this is for a demolition pernit, what year was the building constructed?
If prior to' 1975, you ev!/l need an asbestos assexs rwnt to submit wjM bits a.00 abvrn
Description of Work
*If lawn sprinkler/backnow preventer, most list licensed plumber. If first-time A/C, must list fla nsed electrician.
Subco : U5tthe company name or City of Ft Coigns /kense #
Sedrldan 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 regulatina building mntfnhrtinn r ar.,. , e
r�rm;#- :e . * vna:.1 ....HI k 8. I.cc.. Paul anu aassuea. 4t.yc
Applicant:
Print Name: !S, t�:� gnatue� / lie