HomeMy WebLinkAbout3532 Long Creek Dr - Applications/Furnace - 05/22/2019City of Planning, Developmen4 & Transportation Services
Fort COlhns Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fax 970.224.6134
OVER-THE-COUNTER PERMITS OMLY
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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPetlet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Date May 22, 2019
Sob S-rbe Address (requhred) Value of Construction (labor, note[ als, profit)
3532 Long Creek Drive, Fort Collins, CO 80525 $6750.00
Property Owner Name Address city/State Zip Phone
Donald Lee 352 Long Creek Dr Ft Collins, CO 80525 970-286-3707
Applicant Name Address City/State ZIpp Plane
Christina Evans 1015 Link Lone Ft Co, CO 80524 494-7632
Contractor Address City/5tabe Zipp Phone
Allen Service 1015 Link Lane Ft Co, CO 80524 484-4841
Contradnr City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑Mere ❑ Report
Satestarn=bertsregr&edbyadawhaffi s Are you paying with your bustamourit? IWYes ❑ No
10010
Is this a residential or gpirimercial project? Residential ❑ commercial
If residential, is it "M Single Family Detached ❑ Condo/tawnhome (single fam8yy attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ church ❑ Hotel/Motel ❑ Medial office ❑ office ❑ Retall
❑ Restaurant ❑ Other (explain)
Ls this building 50 years of age or more? ❑ Yes ❑ No ryes,)u may need to aontactHL-4u 'c Pfaswm tin
If this is for a demobiwn permit;, what year was the building constructed?
Description Of work ft " mshngft" andrepl=w"hu camft,
*If lawn sprinkler/baddiow preuenter, must list licensed plumber. If first-time A/C, must fist licensed eleehician.
subcontractors ListBhemmaanynaneorGtyofFtCalbas
Dectridw Plumber M Roofer Other
I hereby acknowledge that 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
perrm-t is not valid rental it has been paid and issued. Applicant: ClwFtnwEvavva
PrinName: SignatureNt a i ( Date 5/-,-Z
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