HomeMy WebLinkAbout1110 Sycamore St - Applications/Furnace - 10/17/2014From
10/15/2014 09:54 #376 P.001/001
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
1AHeating 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 # biL40 55s"
For once use only
Date k-I'I►u
Job Site Address (required)
Value of Construction (labor, materials,
profit)
Property Owner Name Address
City/State Zip
Phone
Applicantlame Address
City/state Zip
Phone
Contractor Address
City/State Zip
a
Phone
Contractor City of Ft. Collins Sales Tax #
saiestarnumber&requiredbyallronbacmrs.
Are you paying taxes here or by report? O Hare
Are you paying with your trust account?,9Yes
Report
tj No
Is this a residential or commercial project? WResidential ❑ Commercial
If residential, is it: 49SIngle 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? Cl Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
rfprior to 1975 you will need an asbestos assessment to submit with this application.
Description of
*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 o(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: [�
Print Name:_ \iCD�P L% hM Signature �._ Date io`k)�)y