HomeMy WebLinkAbout3425 Sun Disk Ct - Applications/Furnace - 01/05/20171412%104-211Pil?'&11STFRUM_ TO:19702246134 FROM:71984P464935d4 T-281raF?07/0107F-639
Ci,ry. t� Planning, Development & Transportation
281 N. College Ave P.O. Box 580
rt Cairns Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 17 Air Conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line ❑ Photo -voltaic
O Ventilation 11 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Oo q U Date JAN 0 5 2017
For ae use only
Sob Site Address (mquked)
3425 (f
Value of Construction (labor, materials, profit)
Su 6V
.V 5, NZ8
party ner Naqe Address
34Z5 Sunf�isk
City/Stu Zip
�f• �' jhs
Phone
Applicad Name Address
City/Stage Zip
Phone
Contractor Address
City/State Zip
Phone
Fort CollinsHeating and Air 209 Commerce Dr. #4 Fort Collins CO 80524
970 484-4512
Contractor City of Ft. Collins Sales Tax it
Are you paying taxes here or by report?
0 Here ❑Report
safer tarmonbcr&repuwmdbyanux baCtrv&
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? IFResidential ❑ Commercial
If residential, is it: O Single Family Detached O Condo/townhome (single family attached) O Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank 0 Bar 11 Church L7 Hotel/Motel 0 Medical office ❑ Office ❑ Retail
❑ Restaurant O Other (explain)
Is this building 50 years of age or more? ❑ Yes ONO If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
!f pr/or to 1975, you wi// need an asbestos assessment to submit with this applira8on.
DescApbon of work
*If lawn sonider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontracmrs: List the company name or City of Ft Collins / wLw +
17ectridan Plumber Mechanical 111309 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:
Prin' lrrrDw pate
Print Name: Angela Morrow Signature