HomeMy WebLinkAbout2414 Dallas Creek Ct - Applications/Furnace - 09/12/201809/12/2018 8:02AM FAX 9704644373
IA0001/0001
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation O 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 # b I�b��1� - & G Date �il
� �2-, t O
For of v use only g I Cb 011? 1 r_ f (r.
Job Site Address (required) 414W
01- Value of Construction (labor, materials, profit 562.o
-TOPWi t CitZ
E e i CDW t,)S CU 802T
Property Owner Name Address
City/State Zip Phone .
AVER 8! 31te µer O N 9�0-484-
Applicant Name Address
City/State ZIP Phone
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C r v �° I tt> 1&4,t k-` N
Contractor Address
J. City/State Zig Phone
V;or_coiiiv.s
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9D:
Contractor City of Ft. Collins gales Tax #
Are you paying taxes here or by report? ❑ Here OW Report
'Wes isrequired byall contractors
Are you paying with your trust account? JI Yes ❑ No
ynumber
-�tax
Is this a residential or commercial project? .Residential ❑ Commercial
If residential, is it: ,Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes AXNo If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
if prior to 1975, you wt// need an asbestos assessment to submit w/bb this appArafion.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed eiectriclan.
Subcontractors: List the company name or City of Ft Coll/ns 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: AwESI1k -PI1�� Wr�.IS tl � qIZi N
Print Name: "A~' l .Signature Date