HomeMy WebLinkAbout3331 Pepperwood Ln - Applications/Furnace - 02/22/2018From: „"02/22/2018 08:34 0923 P.001/001
City of Planning, Development, & Transportation Services
oriCOlEit15 Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 • Main: §70.416.2740 Fax: 970.224.6134
.4 OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
\#Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 Water Heater 0 Water Line 0 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 # Q)\ b Date a&aa),\ g
Farofte we ol*
lob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
3S
Applicant Name Address City/State Tip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft:. Collins Sales Tax # Are you paying taxes here or by report? 513iere 0 Report
3aw "ba- is IWI*edbya#C0n adnvs Are you paying with your trust account? fives ❑ No
Is this a residential or commercial project? t9esidential E3 Commercial
If residential, is it: Ingle Family Detached ❑ Condo/tawnhome (single family attached) 0 Duplex
Multifamily (apartment) 17 Garage
If commercial, is it: D Bank 17 Bar 0 Church ❑ Hotel/Motel D Medical office ❑ Office ❑ Retail
0 Restaurant 13 Other (explain)
Is this building 50 years of age or more? O Yes O No If yes, )au may need to contact HaYwic Prvservatbn
If this is for a demolition permit, what year was the building constructed?
Description of work -�ra k'WAX2
*If lawn sprinider/backNow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ltst Me company name or aty of Cofts licww 0
fteb idan Plumber Mechanical Roofer other
I hereby acknowledge that I have read this application and stage that the above Information Is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and stage laws regulating building consbruction. I know that a
permit is not valid until it has been paid and issued.
Applicant
Print Name: S�!,uz� G.kt?yvyM Signature
ftAsim dMe 2X=17