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HomeMy WebLinkAbout3215 W Prospect Rd - Applications/Furnace - 12/01/2016F®rt Collins I OVER-THE-COUNTER This application is to be ❑ Demolition (interior nor 'JHeatfng Unit ❑ Lawn ❑ Ventilation ❑ Water Hi manufacturer). Complete all applicable Application #, Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 PERMITS ONLY used to apply for the following permits only (check all that apply). ❑ Air Conditioning -structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and For o ce use only on the application. Incomplete applications will not be accepted. Date `Z, /O I / / m Job Site Address (required) Value of Construction (labor, materials, profit) `h O 7Pro rty Owner Name IS Address City/State Zip M; Z4 Phone ( 9 dui 1k. an 3 Z1 � W . ro E t�- 44 - , ()c �_5 731- -1 L M Applicant Name Address Cf ,1)6l� V e�! i; �» � n W v /�' c f— City/State Zip Phone 7 0 i (a �c1 J C� 31 c�^v - I 1 Gv .� Address Contractor J City/State Zip ,`305 3" Phone cl -10 II II }�.z.rj S —4'ati }�, ��(r 4•h) \ LQULk_, l tit U II tV Contractor City of Ft. Collins Sales Tax # saiestax number & required by'allcontactors. Are you paying taxes here or by report? `9 Here ❑ Report 5� Zr0 Are you paying with your trust account? © Yes FbNo Is this a residential or commercial project? 1;3) Residential ❑ 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/Motef ❑ Medical office ❑ Office ❑ 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 prior to 1975, you will ne Ij an asbestos assessment to submit with this application. I Description of work S I I a, I I *If lawn sprinkler/badcflow p ieventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the coiInpany name or Gty of ft Collins license # Electrician 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. Applicant: v I, \n Print Name: i f� �v i2 I G t I Signature II;{� I Date I2-101 // Co