HomeMy WebLinkAbout2031 Creekwood Dr - Applications/Furnace - 12/01/2014Cityof Planning, Development & Transportation
281 N. College Ave P.O. Box 580
�or } l Collins 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 # 12.3 144 Date
For offlce use only
Job Site Address (required)
Value of Construction (labor, materials, profit 29A0,0
Property Owner Name
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Address
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City/State Zip
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PF�one
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Applicant /Name
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City/State Zip
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Contractor
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City/State Zip
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Phone
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Contractor City of Ft. Collins Sales Tax #
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Are you paying taxes here or by report? ❑ Here `y"eport
Sales tax number is required by allcontractws
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Are you paying with your trust account? ❑ Yes JiiQo
Is this a residential or commercial project? R'Residential ❑ Commercial
If residential, is it: �6dingle 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 tOo If yes, you may need to contactNistonc 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/backnow 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—Z3Z1R'tQ4Roo1`er 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 ilding construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: �" G
Print Name: r tt— Signature Date y i