HomeMy WebLinkAbout935 Peterson St - Applications/Furnace - 01/19/2012,1iga
City of
F„ ort Collins
Planning, Development & Transportation
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 (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ 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 # 19 l a003 07 Date I ��� 12
For office use only
7o6 Site Address (required)
Value of Construction (labor, materials, profit)
5
3-1R(, . oo
Property Owner Name Address
City/State Zip
Phone
,-) .e ?35 V C]d
Cry
66 (n8& - 52
Applicant Name Address
City/State Zip
Phone
Contractor Address.
City/State Zip
Phone
H
'2S
7 / - 36 l
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here XReport
Sales tax number is required by all contractors.
.9- a,Ez
Are you paying with your trust account?
❑ Yes No
Is this a residential or commercial project? 4 Residential ❑ Commercial
If residential, is it: N Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, 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 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 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 ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: 1 /
Print Name: l �1 r� ( i y4 O rd Signature
Date I I Q
TO