HomeMy WebLinkAbout4227 Cedargate Dr - Applications/Furnace - 12/20/2016p
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 forthe following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
CrieaBng 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 theapplication. incomplete applications will not be accepted.
Application #� �,�1 Date ✓.fib I j�
Fnr nfrr're use only
Sob Site Address (requ/nod) Value of Construction (labor, materials, profit)
lan-fm5ue *� �-% Q
427-7 Property owner Name Address City/State Zip Phone
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A pilcant Nam ' Address ty/State Zip Phone
SAlern 14ritftAD �• 1. C.ta 5a G
Address City/State Zip Phone
Contractor C 0IWZL
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Contractor Clty of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ' Report
/s Est numbarlsraqulredbya//contractors: Are you paying with your trust account? J*" es II No
IDA/D
is this a residential or coollnercial project? . ETResidential ❑ Commercial
If residential, Is it: Single Family Detached ❑ Condo/bownhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank Cl Bar El Church ❑Hotel/Motel ❑Medical office []Office ❑Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of aye or more? ❑ Yes ❑ No Ifyes, you may need to contact Histnr/cPreservadon
If this is for a demolition permit, what year was the building constructed?
If prior tv 1975, you will need an asbestos assessment to submit with this appl/ca6opn.
Description of work e Yr+o
:"If lawn sprinkler/backflow preventer, must list licensed plumber. If First-time A/C, must list licensed electrician.
subcontractors: List the company name orc7tyofRcomns//mnse #
t]edridan�
Plumber Mechanical 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.
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Applicant: rg' • �► la ZQ&
Print Nam �6/�1�/NSignature ate