HomeMy WebLinkAbout1312 Constitution Ave - Applications/Furnace - 01/04/2013City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
For }L Collins 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). Q Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
VHeating 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. Incomplete applications will not be accepted.
Application # �VO�� bate
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Ownee Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
5(a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
0 Report
Sales tax number isrequrredbyall contractors
Are you paying with your trust account? .9 Yes
a No
Is this a residential. ofilultifamily
mercial project?
If residential; is it:ngle Family Detached
(apartment)
If commercial, is it: ❑ Bank CI Bar ❑ Church
sidential CI Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may needto contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you MY need an asbestos assessment to submit with this application.
Description of work
it lawn spnnxier/oacfctww preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City offt Collins license #
Efectridan Plumber Mechanical 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:
Print Name: ` \ Signature pp � �M
>t..>.�i Date
LOO/LOO'd £86# £Z:VL £LOZ/VO/LO ELOZ£6VOL6 atd XOTTPA a.tpnod:woad