HomeMy WebLinkAbout1917 S Shields St - Applications/Furnace - 06/05/2014Planning, Development & Transportation,
City Ci gg 281 IN. College Ave P.O. Box 580
F�' t rCil I I For Collins, CO 80524
` Phone 070-416-2740 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 Cl 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 # S 1 ! Date
For afrlce use only
Is this a residential or commercial projeetZ ❑'Residential ❑ Commercial
If residentlal, is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) .❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: 98ank ❑ Bar. ❑ Church Q Hatel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to ccntactHistonc Freseruation
If this is for a demolition permit, what year was the building constructed?
lfpr/or to 1975, you will need an asbestos assessment to submit with th/s application.
7�-�
ork �t
ackflaw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
List the companyname.or City of Ft Ca/lins license #
Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information ie 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 Name0_Aj2jzL44il'r Signature Date
/0.10 /5.83-A 3.0q 1,.�z5".ao : J/7.902