HomeMy WebLinkAbout6426 Compton Rd - Applications/Furnace - 11/30/2016Tlea sle-
City/ of Planning, Development & Transportation
Flirt Colti s N` , r�Lt For N. College Ave P.O. Box 580
Fort Collins, CO 80524
K ( Phone 970-416-2740 Fax 224-61M
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
131Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation O Water Heater O.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#-/offy7J7 Date I�-30-/4p
For ce use only
F33ob Slte Address (iepuiied) II Value of Construction (labor, materials, profit)
1.2 4ZCo Com -�Onl Rd • $
Property Owner Name
Kae-eis i
Address
(e'�2-4
City/State
Com a Rd .
Zip
50525
Phone
&?0- oeai6
Applicant Name
Address
City/State
Zip
Phone
Contractor Uc #
Address
City/State
Zip
Phone
tnrntanyrrIl% #-17V 5oI l_ F W,ndwr CO.
goj.`aG
9701vW100�4�
Contractor City of Ft.Collins Sales Tax #
`�g'3�/
Are you paying taxes here or by report? ere ❑ Report
sales tar number ismq&redbya#mnhactum
Are you paying with your trust
account?
yes uZ'No
/�
ekdd"-'' FAi-t
Is this a residential or co
merdal project? [5 Residential O Commercial
If residential, Is it: 13 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
0 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Ca"No Yyes, you may need to contact Histodc Presetvabon
If this Is for a demolition permit, what year was the building constructed?
lfpNor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Reg)4ce. ✓_kr•.+ o
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Uty ofFf Collins. license 0
Electrician ^ r �ra' 51e e, PlumberMechanical 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 A has been paid and issued.
Applicant: � r l/ s t
Print Flame: Signature �. � j��im Date