HomeMy WebLinkAbout518 Charrington Ct - Applications/Furnace - 10/19/201310-19-13;09:30AM; ;970-484-4448 # 7/ 11
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
eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line [7 Photo -voltaic
❑ ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable informations on the application.
Application #
For office use only
Incomplete applications will not be accepted.
Date
Job Spite Address (require
Value of Construction (labor, materials, profit) 0
D
Property Own ame i Address
City/State Zip Phone
Applicant Nam Address
I L.J �1
city/State Zip Phone
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.
ntractor Address
t? I lD / c'3• 1
City/State aO�Zip ,���e�n,/�
. P% a O ai 7 a 7
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? _q Here PReport
Sales fax number�O�u� �byall mmmemrs: T
Are you paying with your trust account?`/ 'Yes I] No
Is this a residential or c mmercial project? FIL Residential ❑ Commercial
If residential, Is It: .51ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
42 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
11 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No IPyes, yaumayneed to contactHistoticPresetvatlon
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submitwith this application.
Description of work
*If lawn sprinklerlbackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins 11cense 0
Electrician 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: S'
Print Name: 1 n Signature
I�Date `�-�