HomeMy WebLinkAbout1917 S Shields St - Applications/Furnace - 09/15/2014City 1 c:
fill S
Planning, Development & Transperaticn
28! IN. collecce Ave '.O. COX 58C
Fort Collins, CO E0524
Phone c70-416-2740 Fax 224-0134
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 Lao
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Phato-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.
Application # -1�) I L4 Dq. XG Date
For office us-- only
Is this a residential or commercial project]. gAesidendal ❑ Commercial
If resldendal, Is it: L; Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
/�- Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ HcteVMotel ❑ Medical office ❑ Office- 0-Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to con(actHistadcPrwarvadon
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 dris apP/icdtlon.
Description of work
V lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: List Me company name or City offt Collins license 9
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. {l
Applicant
Print Narr:Lau r v Signature Date J
3. s-'s%u /f I? s -A%" 3-0i o?s = ./ y 9,;2