HomeMy WebLinkAbout310 W Prospect Rd - Applications/Furnace - 01/09/2014tl FCur� Gvlinlb4P
FROM :NCR ( FAX NO. :9702299983 Jan. 09 2013 10:27AM P1/2
City of
F6rt 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
❑ emolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 17 Gas Log
Heating Unit El Lawn Sprinkler 13 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 # NZ l Date
For olfke use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
State Zip
Phone
CXV
Applicant Name �j
Add�res.�s, ` Oty/State Zip
Phone
`i
.�tJ` \0'
-
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Contractor
Address
City/State ZIP
Phone G'tO
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
XReport
saiesraxnumberisrequlredbyall mnrraaofv.
Are you paying with your trust account? QYes
❑ No
Is this a residential or commercial project? ❑ Residential J!Tcommerdal
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is itrR
ank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office [I Retail
estaurant ❑ Other (explain)
Is this building 50of age or more? Q 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.
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*If lawn sprinkler/backFIow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcorrtracbors: Ust the company name or City of Ft Collins 11canse At
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 bo
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 Nam
Date