HomeMy WebLinkAbout3002 W Elizabeth St - Applications/Furnace - 12/08/2016Plann!39, Development & Transportation
281 N. College Ave P.O. box 580
i",t •tea Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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This-ppfcation is to be used to apply for the following pe7nits only (check all that apply). ❑ Air Conditioning
rl D.:Nmolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
-seating Unit fl Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voitsic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
liianufacturer).
Cnmolete all applicable information on the application. Incomplete applications will not be accepted.
AppliCation
14DI (Lo -�4 ap
For rffice usa only
Date -It� I ' ----
701) Site Address (reyuiiadj Value of Construction (labor, materials, profit)
A )(' 2 L"" F) i 74i �x`1 y D 1 �ic0 s� s t i 5 2 � `l —
Propeity Owner Name Address City/State Zip Phone
1 udGnra L (Sctn-,.c)
A)Dlicant Name Address City/State Zip Phone
KK %0,5aya qo - Syr
Contractors Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑Here .Repo) c
:,;'ems rt� cumber is raqui�rd by'al/contractors Are you paying with your trust account? TL Ues Cl No
is this a residential or commercial project? El ResideqtizC ❑ Commercial _
if residential, is it: ❑ Single Family Detached E1,Condo/townhome (single family, attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank El Bar ❑ Church ❑ Hotel/Motel El Medical office
El fl Retail
❑ Restaurant ❑ Other (explain) —
is this building so 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 piror tv 1975, you Quill need an asbestos assessment 1n submit wide this app/irat on. i
[)ascription of wort:
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" If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, mi.ist list licensed electrician.
Su ;)contra ctors: List the cnmpany nama or City of Ft Co(/ins license ;.4
L""Irarician— Plumber
Mechanical Roofer ' _— Oth'
f 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 ](now that a
I:ermit is not valid un?'il it has been paid and issued.
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