HomeMy WebLinkAbout506 Yuma Ct - Applications/Furnace - 10/07/2014Planning, Developr„ant & Transportation
281 N. Colle_e Ave 0.0. Box 580
For Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply far the following permits only (check all that apply). ❑ AirConditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Loa
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stave (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information an the application. Incomplete applications will not be accepted.
Application # P01 0999 1 Date /0-7-121
For orrice use only
Is this a residential or commercial projeet7• 0 Residential ❑ Commercial
If residential, Is it: VSngle Family Detached ❑ Cando/townhome (single family attached) .❑ Duplex
El Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Nlatel ❑ Medial office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Cl No Ifyes, you may need to contactHlstorfcFreservaG'on
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name cr Cl of ft Cclllns 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: I�Z�
Print Name i signatureDate
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