HomeMy WebLinkAbout2331 Northbrook Dr - Applications/Furnace - 12/28/2016F®rt Collins
: OV;ER-THE-COUNTER
This application is to bi
❑ Demolition (interior not
'Heating Unit ❑ Lawn
❑ Ventilation ❑ Water H
manufacturer).
Complete all applicakl1e,
Application # 19
For office
Planning, Development & Transportation
281 N. College Ave P.O. Box 580 r �/
Fort Collins, CO 80524 h J
Phone 970-416-2740 Fax 224-6134 I U C
?l
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
>prinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
ater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
0
ation on the application. Incomplete applications will not be accepted.
70-7
770F� Date
only
Job Site Address (requireI?d)
Value of Conduction (labor, materials, profit)
C77'5 � d\.oy 14\_� Yuo
C
V1 z)C(7't!
Property Owner Name
YX 0 7u
Address
City/State
Zip 805o(n Phone LgzO�
G-L'e.
7-'3 31 ('Iov
d-bwo-i J
J� . Cs Q1i l_s co .420-9'344
Applicant Name
Ci n � \w rl e�!� 1
Address
453 ��� >r 2 v
n City/State
1 L�[ ��J i E �ci �u�
r Zip Phone 910
(.� b a i �'l GCU -I / 0ti
Contractor J J
Address
City/State
Zip `3i15 3'1 Phone 0-10
Roba.r ' S �i� d..L i r} 4.
i�-j Y
`� 4'1 �','=�! i—iV-�
I�,i` L'� .,i_2..,1 G� %� I) o-0
Contractor City of Ft. Collins Sales Tax #
Sales tax number isrequiredby.7//contactors
Are you paying taxes here or by report? t�Here ❑ Report
_�%No
Jj 7-1
Are you paying with your trust account? {7 Yes
Is this a residential or commercial project? _V Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of'jage 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 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow
Subcontractors: List the
Electrician
r, must list licensed plumber. If first-time A/C, must list licensed electrician.
name or City of Ft Collins license #
Mechanical Roofer
Other
I hereby acknowledge that I gave 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 IIIas been paid and issued.
Applicant:
Print Name: i IJ Tf UY' GL 'I[ . - �{. j \t �i (\ 1 , � !
Signature I Date 12I �I / �e