HomeMy WebLinkAbout1004 Meadowbrook Dr - Applications/Furnace - 06/22/2018Planning, DevAopment & Transportation
—It/ 0, 281 N College Ave P 0 Box 580
Fort Collins, CO 80524
Phone 970-416 2740 Fax 224 6134
OVER-THE-COUNTER PERMIT'S ONLY
This -iuoiication is to be used to apply for the following permAs only (check all that apply) ❑ Air Conditioning
J DPrvul,tion (in tenor non structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Roofing
eating Unit ❑ tewiHeaterk❑ Water ineHome replacement ❑ Wood/Pei et Stove ❑ (must be EPA certrftedepro❑lt
aic
provide make model anal
1 Ventilation ❑ W
manufacturer)
tion on the appjlcaiion incomplete applications will not be accepted
Complete ail npuiicabia mfor'tna
Appliccition #
' -lJ v 'T 1 Date
F7r office use only
--- — Value of cons ton ((labor materials profit) I
Sob site Addi ass (i mnired) 1 l�r^_I —I
f� 0 6 UI �� c r e Zip Phone
- Add ess Crty/Sta li �� l
PI operty Owner Name VA t1/14'11; ) �/l� >WI'3'0
1 1 - Address City/State Zip Phone
AL)plicanl. Name��
tN�I� 5. L,+NJJ 5Zifj� Phone
Conti actor Address city/State ���P
�IL I
� B � ��016 �.Repoi t I
Are you paying taxes here or by report? ❑ Here
Conti actor City of Ft Collins Sales Tax # Are you paying with your trust account? Yyes ❑ No i
e raN ituno ra required by a!/ contractors
Is this a residential or com ca❑Duple c cti project? esidenbai El Commercial
if, esd&ntlal is It ingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multlfamlly (apartment) ❑ Garage
>r comnleivial is it Bank El Bar [] Church other {e0 Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑
Is this building So years
oageor more? t oYes
the buffo If cues, youmay ted? need to contact Histonc Preservation
If ih15 fa for a demolitionpermit
rr pnor tv 1975 you o-wd need an asbestos assessment to submit with this application
Desci ipUon of \A h
i
if lawn spnnkier/b-ickflow preventer must list licensed plumber If first time A/C must list licensed electrician
Su )contractor s List th, company name or city of Ft Collins license # Other
� Li,-lnu3n_ , ____ _.__- Plumber
Mechanical Roofer
i hereby ackn ledge that I have read this application and state that the above information Is complete and correct I agree to
t_omply with all i equirements contained herein and city ordinances and state laws regulating building construction 1 know tha i
i ernvt is not valid until it has been paid and issued
I „13p icanr i
Pt int Name �`P l ��� t '—� — Slcjnature — — —