HomeMy WebLinkAbout2930 Silverplume Dr - Applications/Furnace - 05/15/2015City of r Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins" ^ _.' Fort Collins, CO 80524
(.4/1 V ; Phone 970-416-2740 Fax 224 6134
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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 Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ 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 #810M(9 glSD 3Lo`i l Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
930 S l r
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Prope Owner Name Address
City/State Zip Phone
Ititt krI,30 mil✓
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of F . Collins Sales Tax #
Are you paying taxes here or by report? )d Here ❑ Report
Sales /tax number isrequired byall contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or ScomMercial project? lia'(tesidential ❑ Commercial
If residential, is it: P,8ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/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 Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor 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/Aah,8&1 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: 1-AL; 9 11n Signature Date ��✓� ��
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