HomeMy WebLinkAbout3506 English Ct - Applications/Furnace - 12/07/201612/07/2016 8:01PM FAX 9704844373
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Fort Co►ilins;
Planningr Development t3<Transppl tation
281 N, College Ave P.O. Sox 58o
Fort Collins, CO 80524
Phone 970.416-2740 Fax 224.6134
i
OVER-THE-COLINTER PERMITS ONLY
This application IS to be used to apply for the following permits only (check all that apply), O Air Conditioning
❑ Demolition (interior non-structural) Cl Electrical Alteration (not service change) ❑ Gas Lighter ❑ 6, s Log
9 Heating Unit ElLawn Sprinkler ❑ Mobile Home replacement O Roofing C3 Sewer Line ❑ Photo-Joitaic
O Ventilation 0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide mike, morel and
manufacturer).
Complete all applicable information on the application, Incompleto applications will not be accepted,
_
Application # I CDD4 Cos5 Fake
For Oh7Ce use only --
Job Site Address (required) Value of Construction (la:)or, materials, profit)
Property Owner Name"-3Address—"—^`--"—'-
aty/state z; ,
XV-c'�'• C`�1c�,1� r, al" c354� _fin L p 4.iv eG3
Address 1—
Applicant Name `�� . Pal �;•�-5 C o 5?(v
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City/State Zip
✓/ / ...l r •.Q, • c• , '�•- � ` - r.,._,,�. .' • :�,r, :3 i l_ �C,('�,mv-c� �y�-_ S'' , c: i t! r`•-.. �,s �st��..� �_. Contractor Address City/State Zip
( � �r��nonF Phone
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.0 '%'�^.r.•r�'-"rt�'ti�_r��-i�:�.Ll�.:a�GU. S_U`�.1�•: � t�J(,) '%�"�'.i'>;,I
Contractor City of Ft, Collins Sales Tax # �
Are you paying taxes here or by report? C7 Hegel IS j:e.port
sarestaxnumber isrequkedbyall contractcvs T Are you paying With your trust account?yB�Ye I ❑ No
32..>..•
Is this a residential or commercial preject7 ,MResidentlal ❑ Commercial
If residential, is It: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Du
O Multifamily (apartment) Cl Garage
If commercial, is It: ❑ Bank Q par 0 Church C] Hotel/Motel ❑ Medical office O Office l.J Retail
O Restaurant 0 Other (explain)
Is this buliding 50 years of age or more? 0 Yes I-] No If yes, you may need tc Contact Histor/c Pres4
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 erppllcation.
Description of work
*If lawn sprinkler/backflow preventer, rrust listlicensed plumber. If first-time A/C, must list licensed ela-ctrician.
Subcontractors: List the company name yr City of Ft (-'ollins license o
Electrician—. Plumber � Maehanical�_�
—
^— ___._ Roofer ---
hereby acknowledge that I have read this application and state that the above Inforlriation IS complete and corre
comply with all requirements contained herein and city ordinances and state laws regulating building construction.
permit is not valid until it has been paid and Issued,
Applicant:
Print Name:Lyll0 ,-4�10`� Signatur
.40,�- _Date
agree fo
low that a