HomeMy WebLinkAbout138 Sylvan Ct - Applications/Furnace - 01/17/2013FROM :NCR
FAX NO. :9702299933 Jan. 17 2012 02:08PM P1/2
Fort Collins
Planning, Development & Transportation
281 N, College Ave P.O. Box 580
Fort Collins, CO 80524
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
XHeating 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).
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Application # 0 1 300oL39- - Date - 1-7
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Own 1nam/e f Address
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Gty/State Zip
Phone �C
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Applicant Name Address
City/S e Zip
Phone
Contractor Address
City/State Zip
Phone q_Y0
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here b(Report
Sales tax number IsregWredbyall conbacinrs
Are you paying with your trust account?
I,'rYes ❑ No
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Is this a residential or co mercial project? ;?(Residential ❑ Commercial
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❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar Q Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (expla� )
Is this building 50 years of age or more?,f,ttl Yes )No If yes, you may need to contact H/ston'c Preservation
If this is for a demolition permit, whatyear was the building constructed?
ff prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electridan I✓J e G Plumber _ — Mechanical ,.,,,___ Roofer Other
I hereby acknowledge that I
rnmnhr with nil re'lldrements
Applicant:
that the above information Is comp
s and state laws reguiatingtonding