HomeMy WebLinkAbout730 Mcgraw Dr - Applications/Furnace - 06/03/2014n M a r Planning, Development & Transportation
FCity L 281 N. College Ave P.O. Box 580
®r6#Collins �—✓' Fort Collins, CO80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Ca'!ur Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
l�Fleating 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 # 131402-bill Date
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
--Igo ,rc'w
I SD00
Property Owner Name Address
City/state Tip Phone ci1 O
e `1 C) r,r
7r, F-�, Cok-G l 80 ZLo 966_�! ,-i5
Applicant Name tA Address
City/State Zip Phone
Contractor Address
City/State Zip Phone 9-7b
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Lc)'1-e_ iiar,CA Co e5c)38 Z1556-)0
Contractor City of hJCollins Sales Tax #
Are you paying taxes here or by report? g-ere ❑ Report
seies tax number is required by all mnb wrs.
Are you paying with your trust account? U-Y6 ❑ No
Is this a residential or commercial project? 9-gesidential ❑ Commercial
If residential, is it: Id-S ngle 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 Dl No Ifyes, you may need to contactHistonc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit whir this application.
Description of work
*If lawn sprinkler/backtiow 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 #
Plumber Mechanlml 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: AY�� t�a�e.Y Signature12r� ULd -r Date - :!s- f