HomeMy WebLinkAbout1440 Pikes Peak Ave - Applications/Furnace - 12/29/2017Jan 0418 02:55p
9706198074 PA
Ciof
Fort Collins
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).
❑ Demolition (interior non-sfructurao ❑ Electrical Alteration (not service change) 0 Gas ihr 0 AirConditioning
Log
onmg
❑ Heating unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing
❑ Ventilation ❑Water Heater ❑Water Line ❑ Wood/Pellet Stove (mCl Sewer line ❑ Photo -voltaic
manufacturer). ust be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted."
Application# Ie)OObq I
l=orofce use only Date — �'c��/ 7
Job Site Address (required)
y u o o Value of Construction (labor, materials, profit) P l 1Cf5 Fels, K
t Col l t to I_} �
Property Owner Name Address
engt ee, City(State Zip Phone
ko�i�"im'ICh 1440 P►Ves Fr�c,,K rr Cvl►'Ins L'r� �Sr753tt g7o47a 1764Pplicant Name Address
City/State Z
y p Phone 7 70
Address
City/State Zip X 3.T Phone 97,D
4-97 a i1a ... _ - _ to 1 _ F
Contractor City of Ft. C011inVSaies Tax -
Sa/es tax numberrs reiqufred by 0conbacYors
53 210
Are you paying taxes here orb ? Repn�
Are you paying with your trust account'? O.Yese 0 No ort
Is this a residential or commercial project? 041esidential 0 Commercial
If residential, is it V Single Family Detached ❑ Condo/townhome (single family attached) Multifamily s
e 0 Du ex
If commercial, Is It: ❑ Bank0 Bar 0 Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5p years of age or more? D Yes ❑ No Ffyes, you mayneed to cant&tHistoricP
If this is for a demolition permit, what year was the building constructed? reservatlon
If prior tO 3975, you wi//nead an asbestos assessment to submit with this app/icabon.
Description of work
L.
*If lawn sprinkier/backnow preventer, must list licensed Plumber. If first-time A/C, must Rst licensed electrician.
List the company name or City ofR Collins license
Eiecbldan Plumb
Mechant®I`_ Roofer
---.�_ Other
I hereby acknowledge that I have read this application and state that the above information is complete I agree to
ComP1Y with all requirements contained herein and city ordinances and state laws regulati. a
permit is not valid until it has been paid and issued, ng building construction. and correct. know that
Applicant:
Print flame: K�L tS��P,.- . .
SignaturE
Sate