HomeMy WebLinkAbout1318 Calabasas Ct - Applications/Furnace - 10/29/2014�City ^Cf j73.
Planning, Development & Transportation
281 N. College Ave P.O. Box 58G
For Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER i ER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 11 Air Conditioning
❑ Demolition (interior non-structural) Cl Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Lao
❑ 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 on the application. Incomplete applications will not be accepted.
Application# 1 P+l1 Date%//--;Z9-14
For office use only
job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address Gb//State Zip Phone
Contractor Address city/state Zip Phone
l� a v r i S l g,<2s 9Z, _-;Z9G -86199,
Contractor 'City d R. Collins Sales Tax 41 Are you paying taxes here or by report? Here art
Salestaxnumberisrequiredbya0cOR63Ct0rS. Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial projectl >gesidendal ❑ Commercial
If residential; is it: �ngle Family Detached ❑ Cando/townhome (single family attached) .0 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hctel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact HistoricFreservab'on
If this is for a demolition permit, what year was the building constructed?
Ifpriar 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 or City of 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: iit,/itc Signature / Date /1V
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