HomeMy WebLinkAbout942 BUTTE PASS DR - APPLICATIONS - 7/9/2015Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580 57
Fort Collins, CO 80524 q 2
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 ❑ Gas Log
❑ Heating 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 the application.
Application # 015 0 f ac9a
For office use only
Incomplete applications will not be accepted.
Date �/ I //5
Job Site Address (required)
Value of Construction (labor, materials, profit)
2 &Ahss br
3CW
Property Owner Name Address
City/State Zip
Phone
bL t;M Ass or
52
31-L17 5
Applicant Name Address
City/State Zip
Phone
CUSTOM HEATING INC 395 DELOZIER DR #120 FORT COLLINS, CO 80524 282-7220
Contractor Address
City/State Zip
Phone
SAME AS APPLICANT
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
lere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
31254
Is this a residential or commercial project? PIResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain
Is this building 50 years of age or more? ❑ Yes 12rNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit witfi this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: LlstMecompany name orCityofFtCollins Acense#
Electrician Plumber Mechanical H-1004 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 construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: MICHAEL WETZBARGE
Print Name: �ignature ��c�e-G 1N't�A,f"gEy' Date .S