HomeMy WebLinkAbout3025 Eastborough Dr - Applications/Furnace - 01/09/2017Cii
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 97D-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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
G'Aeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on h, a application.
Application # I __� is
For office tue only
Incomplete applications will not be accepted.
Date / - 9 - )'7
Sob Site Address (required) Value of Construction (labor, materials, profit)
3a�5 Eas bor Dr. $ -;3q15Q=
Property Owner Name
e✓;nl /000re—
Address
94/ne_
City/State
FC.
Zip
8o5-;t3
Phone
4290-,�90
Applicant Name
Address
City/State
Zip
Phone
Contractor lic # Address City/State Zip Phone
6vrit4n 4r Ai- 739 5(a f F_ i'4rcL n W,r,6(9Cr g0 `. 1. 0_ 970 6,9&-4aC 4a
Contractor City of Ft. Collins Sales Tax #� ���/ Are you paying taxes here or by report? l3 _Here ❑ Report
sales tax number ii;fwiiredbyall mntracrors. Are you paying with your trust account? yes „ -No /QJ
0".F 5" 04.4
Is this a residential or commercial project? CBIResidential ❑ Commercial
If residential, Is it: G/Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ®'No Ifyes, you may need to contact H/storic Preservation
If this is for a demolition permit, what year was the building mnstructed?
If prior to 1975, you will need an asbestos assessment to submit witir this application.
Description of work Re, P)&"- FL.-, r•n a.t.Ae
❑ Duplex
❑ Retail
*If lawn sprinkler/bac#low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:Ust the company name or City of Ft Collins license ,#
Electridan W r it'd/ f! f , 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 construclion. I know that a
permit is not valid until it has been paid and issued.
Applicant: �0t� [ l� I� �-
Prirrt Name: �G[� Signature � Date