HomeMy WebLinkAbout2028 Glenmoor Dr - Applications/Furnace - 02/06/2018Planniisg, Developinent & Transportation
i I`% Cl7 281 N. college Ave P.O. Box 580
', Olr t Collin Foie Collins; CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THRCOUNTER P ITS ONLY
This ap .iicallon is to ba used to apply for the follorvirig permits 6hi . (cbeok all #hat apply). 0 Air Conditioning
❑ D ` ioliton (infanor non=structural) ❑Electrical Alteration (not service change) LI Gas Lighter ❑Gas Log
mating Unit Lawn Sprinkler [7 Mobile Home replacement 0 Roofing ❑ Sewer Line O Photo -voltaic
❑ en,tilatlon, ❑ Water Heater 1i Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
manufacturer).
Complete all applicable information on the appllcatlon. Incomplete applications will not be accepted.
1 1 Date 01 I (o' l e
Application # -
For office use only
Sob Site Addy
Cd
Prooerty owner
(requlrad) Vacua of Con strudldon (labor, materials, profit)
Y�en�160r �r 1 �GC� k7sL_i . 5 4 S��OU
Tie Address City/State Zip Phone
. � AqQreSs VILY/NWu:
is this a reslaencal
If 'residential; is it:
If commercial, is it:
Is this Wilding so
If this le, fora der -a
If piior to i975, y
Ft Collins Sales Tax # Are you paying taffies here or by report? ❑Here ' Repo
rgiegtiyeli�nrracro Are you paying with your trust ao ount? ' Yes ❑ IVo
or commercial project? Residential ❑ Conimerdal
®+dingle Family Detad{ed� 0 C orido%to1106me (single family attached) ❑Duplex
'O Multifamily, (apt ent) 0 Garage .
❑ Sank .Q Bar Church 0 Hotel/Motet ❑ Medical office ❑ office ❑ Retail
O ResEaul�nt ❑Other (explain)
year§'dti aSe or more? ❑Yes ❑ No„ Ifyes, you mayneed ib ain�ctHistoncPreservation
olttson perm[i, what year was the building conahvctedi.
ou wlJ/ need an asbe4ms assnssrnent ro stibmit iviih lion.
Description of work
li *Ir lawn sprinide'r/backlow preventer, must list licensed plumber, ff filet tame A/C, must I'Ist licensed electriUan.
Subcontractors: G'st the company name or Oty of Ft Collins license
� t'lecvidan_ Plumber
Mechanlml 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 regulating building construction. I know that a
permit is not valid until it has been paid and issued.
i
I applicant: '..an l�ar�,�t,�.�L�
I Print Name., ''L ,� - b'lgnature� N- _