HomeMy WebLinkAbout517 Smith St - Applications/Furnace - 09/03/2013Frowl'oudre Valley Air 9704932073
08/29/2013 14:49 #523 P.002/003
of
For$ Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box s8o
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
Heating Unit O 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 # B (:304 oE34
For office use only
Date=3-13
Job Site Address (required)
Value of Constru pion (labor, materials, profit) "
Property Owner Name
Address
City/State Zip
Phone
S
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Rinki i
1
a
Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report? ❑ Here
0 Report
.sales tax number Isrequiredbyall cw&actom
Are you paying with your trust account? )KYes
Q No
Is this a residential or commercial project? esidential ❑ Commercial
If residential; Is It: mgle 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 morel ❑ Yes ❑ No Dyes, you may need to contact H&olYcPresecvabbn
If this is for a demolition permit, what year was the building constructed?
Zf prior to 1923, you willneed an asbestos assessment to submit` wldi this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or City of R Collins license >r
Electrician Plumber Mechanical Roofer Omer
I hereby acknowiedge 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: n\C.D\? +%n Signature ir �.a . • ��— Date aq1
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