HomeMy WebLinkAbout1633 Larch St - Applications/Furnace - 12/08/2016'1712%JP07-Z0hO )Z:T4PII STFROW _ TO: 19702246134
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FROM: 71�4P4A4H 4 T-865 aF001/00Z 1F-581
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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable
�informationon the application. Incomplete applications will not be accepted.
Application # Il J4; j I I
For office use only
Date Ol e r W l t o
Job Site Address (required)
Value of Construction (labor, materials, profit)
1�033 l arch --.
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MJName
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Address
lei
City/State Zip
Cf
Phone
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215-1 P1
Applicant Name
AcYdress
City/State Zip
Phone
Foil Colling HeiWng and A *r 209
Commerce
Dr- #4 Fort Collins Co 5
Contractor
Address
City/State Zip
Phone
Fort Collin5 Heating and Air 208 Commerce Dr. #4. Fort Collins CO 80524
970 494-4552
Contractor City of Ft. Collins Sales Tax
Are you paying taxes here or by report?
❑ Here ❑ Report
Safffraxnanberafyui-edbyaticonnacors
Are you paying with your tivst account?
❑ Yes ❑ No
Is this a residential or commercial project? $T&esidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ❑ No If yes, you may need to contact Historic Preservatroii
If this is for a demolition permit, what year was the building constructed?
Ifpmr to 1975, you wv// need an asbestos assessment to submit wldr this application.
Description of work
*If lawn sOnkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subeonb*dnra: Ust the company name or Qty of Ft Collins license .0
Electrician Plumber Mechanical H1309 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 bullding construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: / - taY XJ Date
Print Nance: Angela Morrow signature