HomeMy WebLinkAbout809 Southridge Greens Blvd - Applications/Furnace - 11/27/2013FROM ' : NCA
FAX NO. :9702299983 Nov.- 27 2012 11:17AM P1/1
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
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line a Photo -voltaic
Ci 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 # 0 2 Date'�L -
For office. use only
Soh Site Address (requlred)
aS
Value of Construction (labor, materials, profit)
,
PropertyOwner Name Adress
ity/State Zip
Phone
SO
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Applican a Address
Ci /Sta Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
XReport
saleseaxnumber isrequlrodbyall contriew-9.
Are you paying with your trust account? KYes
❑ No
Is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: ingle Family Detached ❑ Condo/townhome (single family attached) El Duplex Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank C1 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) _
Is this building 50 years of age or more? Q Yes ,GAo If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
1f pr1cr 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 0
Electrician Plumber Mechaniutl 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, x know that a
permit is not valid until it has been paid and Issued.
Appikant:
Print Nam
Date I