HomeMy WebLinkAbout6703 Antigua Dr - Applications/Furnace - 05/18/2015Ciof
Flirt Collins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
.'r-,•Phone.9.70-416-2740 Fax 224-6134
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This application is to be used to apply for th461ow_linq permits onii (check all that apply). ❑Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration not -service change) ❑ Gas Lighter ❑ Gas Log
Weating 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).
application. Incomplete applications will not be accepted.
Complete all applicable information on the
Application # e (6o L4d00
For office use only
Job Site Address (required)
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Property Owner
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nt Name
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Contractor
Address
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Address
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Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
53 y+0
Date 5 1 18� 15
Value of Construction (labor, materials, prom)
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City/State
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Phone
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Are you paying taxes here or by report? W Here ❑ Report
Are you paying with your trust account? 17 Yes ❑ No
Is this a residential or -commercial project? 1A Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ['Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? El Yes ❑ No If yes, you may need to contact Historic Preservation
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 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 Col/ins //tense #
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: C I tia VJ h21 C, we Signature �j u Jai (..�,� Date 5 I 15
Print Name: