HomeMy WebLinkAbout3401 Camelot Dr - Applications/Furnace - 12/06/2016Dec 06 2016 10:16AM PERFECT TEMP 970-292-8699 P.1
otCOttins,
Planning, Development, &
Community Development
261 North Collage Avenue
Fort Collins, CO 80624
Transportation Services
& Neighborhood Services
970,416.2740
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
A -Heeling Unit ❑ Lawn sprinkler ❑ Mobile Home replacement ❑ Roofing. ❑ Sewer Line ❑ Photo-voltsic
O Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on jthe application. Incomplete applications will not be accepted.
Application # �I �QI ✓ TLJ Date Ztx —4oi-
For o/Plce use only
Job Site Address (mqu#d) Value of Construction (labor, materials, profit)
Property Owner Name Address Clty/State Zip Phone
Applicant Name Address Clty/State Zip Phone
t1gys 4a7TS 646 49✓y yewAvz. Lev o61'7 a- q9 3
Contractor Address City/State ZIP Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales t"t7unbff/Snquhrdbyaryi�rn+. pa�o�f. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, Is It: Single Family Detac ed ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Churl: ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ other (ex
llain)
Is this building 50 years of age or more? ❑ Yes J� No Rryes, mu may need to contact H/stbrYc pmser &w
If this Is for a demolition permit, what year was the building constructed?
Description of work O
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must Ilst licensed electrician.
Subcontractors: Ust Me company name or Cfey of Collins I/dense 0
Eledrldan Plumber. Mechanical - ` 3L Roofs Other
I hereby acknowledge that I have read this application and state that the above Infomtatton 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: / -� C
Print Name: CNR, IS �L(.I Y -� slgnawre Date %1 "40'%40
Revised 11 @MIS