HomeMy WebLinkAbout1407 Cactus Ct - Applications/Furnace - 05/02/2014City of
ort Collins
Planning,. Development & 7ransporUtion
281 N. College Ave P.O. Box 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 (cheek all that apply). ❑ Air Condltioning
❑ 17err6ition (interior no6zhudunal) 0 ❑ec Wc21 Alteration (not service change) Q Gas Lighter ❑ Gee Log
p Heating unit ❑ Lawn Sprinkler ❑ Mobile Home repleoefrierit ❑ Roofing ❑ Sewer Vns ❑ Photo-voitaic
❑ Ventilation ❑ VVeter Hester ❑ V*r Line ❑ Wood/PellSt Slays (" be EPA certified, provide riake, model and
manufacturer). .
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application * 0/.+
Far ofte use only
]ob
Owner Name.
WE
Address
Contractor :.. Address
Contractor City of ft Collins Sales Tax #
sales tax ft by aNcvahs tM.
Date
Value of Corlplructlpm (labor jr oterlals, profit)
rte zip P
City/state zi
P
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ Yes , ❑ No
is this a residential or mercial project? %�tesidentlal ❑ Commercial „
If residential, is tt:; WSingle•Famlly Detached 13 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, ls1ti ❑ Bank ❑•Bar Cl Church CI Hotel/Motel ❑ Medical bMce' D Office %i Retail
❑ Restaurant ❑ Other (expl i
is this building So -years of age or more? ❑ Yes Eno If^ You n*je >&tqttocontact H/sforic Avsemebbn
if this is for a demolition permit, what year was the building constructed? '
IPprior to 1975, You wilt Wof an &The fios assessment to sr bnilt W/fb this app/lcetron-
Description of work_
*If lawn sprinkler/bac0ow, preventer, must list licensed plumber. If first-time A/C, must list licensed eL-dildan,
Subcontractors: List die company nenrei, or M eFt CW/ins /irnnse�0. f{
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 6rdln4hce1;and stote'lam regulating building construction. I knowtilat e
pemit is noR vat wrdl it.has been paid and issued.
Applicant:+��� �,?/ /
Print Name.