HomeMy WebLinkAbout829 Jutland Ln - Applications/Furnace - 12/30/2016PiarinVig, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins CO 80524
Phone 970-416-2740 Fax 224-6134
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This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Dein,oCtion (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
B<Ieating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provicle make, modal and
manufacturer).
Complete 'all applicable information on the application. Incomplete applications will not be accepted.
Application # y)I I\�\ 1 `1 U Date -
Fit nfff'ca LlSe Oniv
Sob Site Address (requr J Value o'I Construction (labor, maAerials,�r0Ill0
351
Property Owner Name Address _ City/State a/ Zip hone
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Applicant Nam Address C/State up Phone
5.
Contractor. Address City/State Zip Phone
Conti actor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ' �Report
:Jl;s mn numba-isrequiredbyal/contractors. Are you paying with your trust account? ttYes ❑ No
Is this a residential or c0VJI �nercial project? Residential ❑ Commercial
If residential, is it: EYSingle Family Detached El Condo/tow
(single family attached) ❑Duplex.
❑ Multifamily (apartment) ❑ Garage
it commercial, Is it: ❑Clank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical offce ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) —
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed 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.
I Descrip+eon of work _R_r '«, e �----
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Tit lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
SubconY,ractors: List the company name or City of Ft Collins license.#
HoLtrician__.— Plumber Med)anical Rooter — Offier
(l 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 requiremenCs contained herein and city ordinances and state laws regulating building conslnlCtiort. i know the t a
ern" - is not valid until it has been paid and issued,
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Print Nam,. r_ a Signature _ ate�..----