HomeMy WebLinkAbout3830 Arctic Fox Dr - Applications/Furnace - 09/12/201809/12/2018 11:31AM FAX 8704844373
120001/0001
F6r-t Collins
tiI•
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
.OVEReATME-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 13 Gas Log
❑ Heating Unit Cl Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 17 Sewer Line 11 Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ 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 # aJ I (b O 1619 Date � 11atW Cy
For ofte use only
Job Site Address (required) 3 A1'044
lig -mef f'i1t5oG
Value of Construction (labor, materials, profl) 7�(p, fA
.Co
Y16n a
J2Jr. jrj�33) - 51
Property Owner NaMe Address
City/State Zip Phone
- r)aw ia orrti 'Dr:
ca $B52010-491--4441)
Applicant Name Address
Cty/State Zip Phone
`
ll? ,
Or.ye,
Contractor Address
IfGty/State ZIP Phone
la ce
Foc--l-Coll-YES
flr L,1
Contractor City of Ft. Collins gales Tax #
Are you paying taxes here or by report? ❑ Here WReport
&PiesraxnumberIs,equiredbyapconrr MM
Are you paying with your trust account? JQ Yes ❑ No
311RfoS.
Is this a residential or commercial project? b&esidentlal ❑•Commercial
If residential, Is It: mangle Family Detached ❑ Condo/townhome (single family attached) '❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank CI Bar ❑ Church 0 Hotel/Motel ❑ Medical office O' Office ❑ Retail
❑ Restaurant ❑ Other (explain
Is this building 60 years of age or more? OYesA5,,Np lfyes, you may need to contact N1sMrlc Preservation
If this is for a demolition permit, what year was the building constructed?
.1fprior to 1975, you will need an asbestos assessment 10 submit w1th th/s appllcadan.
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name orCity ofRCollins license
�
Electrician 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 regulating building construction, I know that a
permit is not valid until it has been paid and issued.
Applicant: ,) I 1 ?,
Print Name:�(s;r JPia ltl t�( Signature ✓v Date