HomeMy WebLinkAbout375 Aurora Way - Applications/Furnace - 11/15/2013Cit Of Planning, Development Sc Transportation
FY 281 N. College Ave P.O. Box 580
ort 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
❑ 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 he application. Incomplete application will not be accepted.
Application # �') f�ca0a Date ��5�/3
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Na e
Address City/State
30gf-�e.�,;.
Zip
,717G
Phone
Applicant Name
Address
City/State
Zip
Phone
Contractor`` Lic #
� C- /�l Zl3
Address
12 ��ZS Q��1
City/State //
t✓` 1� C,
Zip
�Y�SS`i
Phone
6 P?J
Contractor City . Collins Sales Tax #
Are you payin xes here or by report?
❑ Report
Sales tax number Isrequlredbyall contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? AResidential ❑ Commercial
If residential, is it: )Pingie Family Detadhed ❑ Cohdo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes �o If yes, you may need to contact H/storlc Preservation
If this is for a demolition permit, what year wa a building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacldiow 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: /
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