HomeMy WebLinkAbout700 Mcgraw Cir - Applications/Furnace - 12/11/20149 6 9s7 �
Planning, Development & Transportation
City 281 IN, Colle_e AVE P.C. Cox 58
+"* For Collins, CO 60524
/~^ Phone 470-4ic-2740 Fax 224-6134
OVER- i HE-COU,N T EIR PERMITS ONLY
This application is to be used to apply for the following permits only (check all that applyj. ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Rome replacement ❑ Roofing Cl Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Woad/Pellet Stave (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
gILi IZ(01q—Fvrrnace ;
Application # R 19 12(091— w rntcep- Date
For ofce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
DO i�'I r-�100 . d0
Property Owner Name Address CIty/SSttate Zip Phone
t' `
Applicant Name Address Qb//State Zip Phone
Contr/actor Address City/State Zip Phone
Contractor City Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ort
Sales tax number is required by 9 contactors. Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project7. "�YResldential ❑ Commercial
If residential, Is'it: VSngle 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 mare? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlorto 1975, you wi//need an asbestos assessment to submit with &sapplicadcn.
Description of work
*If lawn sprinkler/backFlaw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or CRy afR Collins license #
Bectrician Plumber Mechanical Racier 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: i Signature Date Z� /,
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