HomeMy WebLinkAbout817 Parkview Dr - Applications/Furnace - 11/05/2013FROM :NCA
FAX NO. :9702299983 Nov. 05 2012 02:06PM P1/3
Fart Collins
Planning, Development & Transportation
281 N. College Ave P.O. sox 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
O emolition (interior non-structural) Electrical Alteration (not service change) ❑Gas Lighter ❑ Gas Log
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Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 4 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 # Date
For office use only
fob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name I Address City/State Zip Phone
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Applicant Name Address
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Contractor Address City/State Zi
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here KReport
Sales tax number IsrWuiredbyall contreMm, Are you paying with your trust account? IXYes O No
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Is this a residential or Co mercial project? XResldential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If Commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hatel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes fd'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 appllcaoon.
Description of work
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*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractore: List the company name or City of Ft Collins !!tense A'
ElWridan Plumher. Mechanlcal_, ROAr 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.
Applb
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