HomeMy WebLinkAbout901 GROUSE CIR - APPLICATIONS - 4/19/20171111112918-20111list&` MFItIJIJFT
TO: 19702246134 FROI�i�41ahVO7234 T-1T5 P.004/Otre : F-588
City.
1"t Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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
O Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable it formaUono//n��the`appplication.
Application # (b 17 G U3 "1'
For office use only
Incomplete applications will not be accepted.
Date
Job Site Address (rt Wired)
Value of Construction (labor, materials, profit) a i, 5
Ctir
Fail CQ A05242.
Property Owner Name Address
City/State Zip
Phone
s CO2 40G.212.13V
Applicant Name Address
City/State Zip
Phone
Fort Collins. Heating and Air 2OR Commerce
Dr- #4 Fort Collins, CO 5
Contractor Address
City/State Zip
Phone
Fott Collins Heatine and Air 208 CoMMerce
Dr. #4 Fort Collins CO 80524
970 484-4552
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
SAW tUawnberaraWkedbyaraxtracfars
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or�ercial project? WResidential ❑ Commercial
If residential, is it: 6aSingle Family Detached ❑ Condo/townhome (single family attached) l7 Duplex
Cl Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office O Office ❑ Retail
❑ Restaurant El Other (explain)
is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Prese ot/on
If this is for a demolition permit, what year was the building constructed?
Yprfor to 1975, you w1fl need an asbestos anent to submit wiUr arts app#/cadon.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the avnpany name or oty of ft Cb11h7s 1k:enm ,0
Elecloidan Plumber Mechanical H1309 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 la regulating building construction. I know that a
permit is not valid until it has been paid and issued. /% WA ,A
Applicant:
Print Name: Angela Morrow Signature
Date 1 /9/
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