HomeMy WebLinkAbout1707 Larch St - Applications/Furnace - 09/26/2014Planning, Development & Transportaticr,
28i N. Colle^_e Ave P.C. Eox 580
For Collins, CO 80524
Phone c70-416-2740 Fax 224-5134
OVER-THE-COUNTER PERMITS CJNLY
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 # f, l '�0 Date y' o26 -/z/
For office use only
Is this a residential or commercial projeda XResidential ❑ Commercial
If resldenttal, Is It: ;single Family Detached ❑ Cando/townhome (single family attached) .❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office- ❑ Office ❑ Retain
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No lfyes, you may need to contactHistaHcPresevvabon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this app/ic3ton.
Description of work
*If lawn sprinkler/badflcw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Su bcontractors: List the company name or QY 01'R C011in5 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:
Print Nam
Date
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