HomeMy WebLinkAbout401 Linden St - Applications/Furnace - 10/30/2013Cit YOf Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Folrrr►►} 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration. (not service change) ❑ Gas Lighter ❑ Gas Log
t.Heating 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 #;E �� S� / Date 10 / Sol I
For office use only
Job Site Address (required) .. Value of Construction (labor, materials, profit)
qo $
Property Owner Nam
Address City/Stat Zip
L-Im �a1 J l CiO doh
Phone
149a-43
Applicant Name
Addresstate Zip
Ae :
Phone/So32D
Vep_
000
Contractor _ Lic #
Address City/State Zip
Phone
f F� t�
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report? PHere • ❑ Report
sales tax number Is required by all contractors
Are you paying with your trust account? ❑ Yes
No
Is this a residential or commercial project? ❑ Residential Commercial
If residential, Is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel �MoQtel office ❑ OfFlce ❑ Retail
❑ Restaurant ❑ Other (explain) /N-b ot1—
Is this building 50 years of age or more? ❑ Yes ANo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If 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 #
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:
Print Name:
Date 10 3o 1