HomeMy WebLinkAbout617 Cornell Ave - Permits/Furnace - 09/06/2005Community Planning & Environmental Services —10
Building & Inspections Division BUILDING PERMIT
i PERMIT FEES
P.O. Box 580 281 N. College Ave.
Building Valuation
Fort Collins, CO 80522-0580
City of Fort Collins phone (970) 221-6760 Fax (970) 224-6134
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ACCOUNT
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Plat File No.
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Subdivision/PUD Filing
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Lot
Block Lot Area r} Parcel No. r
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Name Contractor License No.
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City/State
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Supervisor Cert. No.
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Electrical License No.
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License No.
Roofing
License No.
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Framing
License No.
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License No.
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Concrete
License No.
REPLACE FURNACE
As a
condition for the issuance of a permit, I hereby declare that I am an owner or the owner's agent, authorized to perform the proposed work on the property
described
herein. I agree to comply with all City ordinances, and State laws associated with such work. I understand that such permit may be revoked in the
event
that issuance was based on incorrect or incomplete information. This permit shall become null and void if the work authorized by such permit is not
commenced,
suspended, abandoned or inspected within 180 days from the date of such permit or from the date of the last inspection.
name of owner/agent Signature Date
Print
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$15.