HomeMy WebLinkAbout1474 Front Nine Dr - Applications/Furnace - 05/06/2015FROM :NCR FAX NO. :9702299993 May. 06 2015 03:18PM Pi/l
City o
Planning, Development & Transportation
281 N, College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 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), ❑ Air Conditioning
Q Demolition (interior non-structural) ❑ Electrical Alteration (not service change) _ ❑ Gas Lighter El Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation ❑ Water Heater ❑ 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 #Date`j
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
city/State rt.Zip
1
`Phone
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Applicant Name
Address
City/State Zip Phone
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Contractor
Address
city/State P-00111kczip Phone Ol )'0
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? JKlere ❑ Report
Sales tax numberlsrequlredbyollcontmaom
Are you paying with your trust account? es ❑ No
Is this a residential or c , mercial project? PfResidential 0 Commercial
If residential, is it: V3 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office CJ Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 17 Yes KNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year waste building constructed?
Itprior 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 ar G'ty of Ft Collins license #
Electridan 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 Nam
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