HomeMy WebLinkAbout514 Peyton Dr - Applications/Furnace - 11/12/2019Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580,
Flirt Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
T ' application is to be used to apply for the following permits only ( heck all that apply).
Air Conditioning ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log eating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 # UV ` Date 11/12/19
For ofce use only 1 (�� l 0
Job Site Address (required)
Value of Construction (labor, materials, profit)
514 Peyton Drive
a 3 m 5. Hig 4V)1,17toc h
Property Owner Name Address
City/State Zip
Phone
John Androsky " 514 Peyton Drive, Fort Collins, CO 80525 USA
(970) 692-9517
Applicant Name Address
Citv/State Zip
Phone
a 4600 Innovation Dr. Suite 102 Fort Collins CO 80525
970-,399-9940
Contractor Address
City/State Zip
Phone
Benjamin Franklin Plumbing 4600 Innovation Dr. Suite 102 Fort Collins, CO 80525
970-399-9940
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here. &I report
Sales tax number isrequired byall mnbactors
Are you paying with your trust account?
� ❑ No
52310
Is this a residential orMpmfercial project? Li Residential ❑ Commercial
If residential, is it: 12 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/M tel` E Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes No Ifyes, you may need to contactH/storicPreservadon
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City, of Ft Collins license #
Electrician Plumber Mechanical h 33 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: rnd df 11 6 U� Print Name: /it Signature
Date
11/12/19