HomeMy WebLinkAbout509 Cornell Ave - Applications/Furnace - 11/20/2013Cit of Planning, Development & Transportation
Fort Collins SI 15 For N. College Ave P.O. Box 580
Fort Collins, CO 4
Phone 970-41616-27402740 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 the application. Incomplete applications will not be accepted.
Application # I �D ��2c� Date
Fo oelce use only
.lob Site Address (required) Value of Construction (labor, materials, profit)
$ ;�20, oa
Property Owner Name Address
City/State
Zip
Phone
,6�v- i wx Y) 50 9' Ge rrl ell
$oy25
4 /:ir
Applicant Name Address
City/State
Zip
Phone
Contractor Lic # Address
Cityy/State
Zip
Phone
C�; 2/37 P :.a T7" ,t 1i;T
69 gdrZ,(!� 2Z3lfl7
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report3,1ir-Here
❑ Report
sales lax number is required by all convaciom
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: ETOS�ingle 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 more? ❑ Yes ❑ No 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 ' K< P I a_c �C f-v rn a c -C
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty 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• 4rren cuww f
Date / i Zo -/ 3