HomeMy WebLinkAbout6301 Southridge Greens Blvd - Applications/Furnace - 02/27/2015Resend03-06-15;03:55PM; ;970-484-4448 # 5/ 13
City. of Planning, ueveiopment: & Transportation
�ege Ave tLtins�' CoFort Coll281 N. ins, CO 0524 P.O.
Box 580
Phone 970416-2740 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). Q Air Conditioning
.9 Demolition (Interior non-structural) 0 Electrical Alteration (not service change) 13 Gas tighter ❑ Gas Log
eating Unit 17 Lawn Sprinkler O Mobile Home replacement ❑ Rooting Q Sewer Line ❑ Photo -voltaic
❑ Ventilation O Water Heater O 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 # 15y J� 11 Date For of cu use only
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]ob Site Addre (requl`�J /� Value of construction (labor, materials, pront)
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Pr erty Owner Name Address
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City/State
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Phone
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Applicant NameA Address
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Contractor City of Ft. Collins Sales Tax #
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Are you paying taxes here or by report? C1 Here PRel
Are you paying with your trust account? Yes 11 No
Is this a residential ar commerdal project? 1 IkResidentlal 13 Commercial
If residential, is it: Single Family Detarhdd Q Condo/townhome (single family attached) i7 Duplex
Multifamily (apartment) Q Garage
If commercial, is it: Q Bank ❑ Bar ❑ Church ❑ Hotel/Motel O Medical office M Office r3 Retail
❑ Restaurant 13 Other (explain)
Is this building 50 years of age or morel O Yes Cl No Ifyes, you may need to contactHlstojicj*war*b'an
If this Is for a demotition'permit, what year was the building constructed?
Ifprlorto 1975e you w/f/reed an asbe&os asmssment to submit ivjr &sapp/kadon.
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llstdre comparryname orGtyofh7Coff%ns/Ice1;" 0
Electridao Plumber. Mechanlmi 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:lL.RPrint
Name ln' Signature Date ����