HomeMy WebLinkAbout6321 Buchanan Ct - Applications/Furnace - 10/31/201311-01-13;09;07AM; ;970-484-4448 # 11/ 11
Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collinsr 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 Anterior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
teang Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
ent�ilation ❑ Water Heater ❑ Water Line d 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 # '�7I 2 (n Date /0 -'�!
&roffice use only
Sob Site Add s (required)
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IValue of Construliion (labor, materials, prop'
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City/State Zip Phone
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City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here Report
Sales tax number �mq z �by all contractors
Are you paying with your trust account? Yes ❑ No
Is this a residential or 9mmercial project? esidential ❑ Commercial
If residential, Is it: ingle Family DetacKed ❑ Condo/townhome (single family attached) ❑ Duplex
Jj 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 contactHlstoric 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 applicadon.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If Flrst-time A/C, must list licensed electrician.
Subcontractors: List the Company name or City of FtColllns 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:Crl-go
Date
10-3I-1J