HomeMy WebLinkAbout6410 Compton Rd - Applications/Furnace - 02/13/2017:/1/2%701-Z0R917:01PAISTFROM_ TO:19702246134 FROM:719AF4A4H 4 T-588ap007/00a 7F-505
Planning, Development & Transportation
City af 281 N. College Ave P.O. Box 580
Fort Collins 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Cl Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
O Ventilation ❑ Water Heater ❑ Water Line O 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 # ✓ �� .� Date 2'
For oflyae uae only
lob Site Ad ress (mqulmd)
CoyID 11d.
Value of Construction (labor, materials, profit)
151-1t.1S;
pertyr Na Address
If r ��1t co
Ci /S
`) Pi. of
Zip Phone
llins 9051;15 b_��_22a�
Applica4t Aame Addreks
Fort Coiling HeatilIg and Air 208 rommerce
City/State Zip
Dr- #4 Fort Coll6ing CO 80524
Phone
(970) 305-3479
Contractor Address City/State Zip
Fort Collins Heatine and Air 208 Commerce Dr. #4 Fort Collins CO 80524
Phone
970 484-4552
Contractor City of Ft Collins Sales Tax #
Sales tar number®wredbyamonp-acrax
Are you paying taxes here or by report?
Are you paying with your trust account?
❑ Here ❑ Report
❑ Yes ❑ No
Is this a residential or commercial project? 1151kesidential ❑ Commercial
If residential, is it: IFSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank O Bar ❑ Church ❑ Hotel/Motel O Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 yearsof age or more? O Yes ❑ No If yes, you may need to contactHisroric Preservamon
If this is for a demolition permit, what year was the building constructed?
IfA7or to i975, you wt// need an asbesrns assessment to submit with ttus application.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or 01y of Ft Coffins license 0
SeCbldan^` Plumber Mechanical H 1309 roofer
Other
I hereby admowledge 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.
Appikant:
Print Name: An la Morrow signature
vate I /Z7/ 1