HomeMy WebLinkAbout2420 Sheffield Cir - Applications/Furnace - 02/19/2014planningeveloprrtent &Transportation
City of 28, i)
1 N; College Ave P.O. Box 580
F6 `t Conies Fort Collins, CO 80524
- phone 970-416-2740 Fax 224-6134
OVIMTHE-COUNTER PERMITS ONLY
This application is to tie used10 apply.for the following permits only (check.all that apply] ❑ Air Conditioning
❑ Demolition (interior non-structura ). ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
M Heating U nit ❑ 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 # 12140Og 1 Co Date T • 19 2b1�{-.
For affi a use on*
]ob Site Address ukw)
Value of onstructio (labor, materials, profit)
roperty Owner Name Address
C4/Sdah r Zip Phone9r' ni.
Applicant Name Addre
Cff4CPO� �r 7 G�
City/State Zip Phone
. rp . 00 oca 9�0 ��� L7L-,-,a
Contractor Address
City/Stab Zip Phone
�a-
Contractor City of Ft Collins Sales Tax #' :..
Are you paying'. taxes here or by report? ❑ Here ❑ Report
Sales taxru ;s byN1cmtrecfa-s.
Are you paying with your trust account? 13 Yes ❑ No
Is this a residential or commercial project? tRftesidential ❑ Commercial
If residential, is it: (465ingle Family Detached ❑ CondoADwnhome (single family attached) 13Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: O Bank ❑ Bar ❑ Church ❑ Hotel/Motel D Medical office ❑ OFF= ❑ Retail
❑ Restaurant ❑ Other (explain) _
Is this building 50 years of age or morn? ❑ Yes C) No If yes, you may deed of conbctHadDrrc FteservaDbn
If this is for a demolition permit, what year was the building constructed? m
If prior b 1975, you w ll need an asbeslas asm%sm4wt rb submit with [firs appflcabon.
Description of work
*If lawn sprinlder/badcflow preyenter; must list llcensed plumber. If first-Urne AJC, must list licensed electrician.
Subcontractors: Ust Me company name or City ofPit CoAhs 1ker2m. # ,
Electrldan Plumtw_
W&Srical f7fLr3 /0 / Roofer
I hereby aclmowledge 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 constructlon. I {mow that a
permit is not valid until It has-been paid and Issued.
Applicant:
Print Name: Signature _ Date