HomeMy WebLinkAbout1917 S Shields St - Applications/Furnace - 05/15/201467a q 9'
Planning, Development & Transportation
City 04 m 281 N. Collece Ave P.G. Eox 580
-6j rC Co It For Collins, CO 8O524
Phone 970-4IE-2740 Fax 224-6134
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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 (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Cl Gas Lag
❑ Heating Unit ❑ 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 # h1grjZ6Li0 Date 5V_5_-/�
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XRepert
sa/esm/x///numberis refq/sired by a//mntraeYas Are you paying with your trust account? ❑ Yes No
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Is this a residential or commercial projectl Nesidendal ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
Muldfamily (apartment) ❑ Garage
If commerdal, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mete) ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifye* you may need to contact HistvHcPreservadon
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. -
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Rooter 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 tifLt-Fi r^,` ,c Signature Date
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