HomeMy WebLinkAbout1519 Brentford Ln - Applications/Furnace - 01/06/2020Fort 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating 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 #' MA IW " WOE C' Pate
For office use only ?, 7 f Y)) I U1
12/31/19
Job Site Address (required)
Value of Construction (labor, materials, profit)
1519 Brentford Lane
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Property Owner Name Address
City/State Zip
Phone
Kathy & Jay Pontius 1519 Brentford Lane,
Fort Collins, CO 80525 USA
(970) 223-1032
Applicant Name Address
City/State Zip
Phone
4600 Innovation Dr. Suite 102 FortCollins CO 80525
970-399-9940
Contractor JrM )J�" IYIC. Address
City/State Zip
Phone
Berraffrn—FTa-n-RMrPM`mbTn-g 4600 Innovation Dr. Suite
102 Fort Collins, CO 80525
970-399-9940
Contractor City of Ft. Collins Sales Tax #
Are paying taxes here or by report?
❑r,�,,te/ Report
sales tax number isrequiredbyallconbacto
a you paying with your trust account?
Y❑ es ❑ No
52310
Is this a residential or c9e(imercial project? 11 Residential ❑ Commercial.
If residential, is it: I Single Family Detached ❑ Condo/townhom mgle family attached) ❑ Duplex
❑ Multifamily (apartment) El Garage
If commercial, is it: ❑Bank ❑Bar ❑Church ❑Hotel el ❑Medical office ❑Office ❑Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
*If lawn sprinkler/backflow 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 )i 19 3I 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: ft Q
Print Name: U'�/ � � Signature
Date
12/31/19