HomeMy WebLinkAbout2625 Bison Rd - Applications/Furnace - 02/18/2015Resend02-19-15;08;56AM; ;970-484-4448 # 12/ 16
Planning, Development &Transportation
Fdcity. f +✓t 281 N. College Ave P.O. Box 580
r'i o1.fins Fort Collins, CO 80524
Phone 9711416-2740 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
❑l Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Reating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation. O 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* Mo I �a& Date "! "-15
Foroff/ce use only
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Value of Construction Qabor, materials, profit)
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Property Owner Na
Address
City/State Zip
Phone
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Applicant loam
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Address
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City/State Zip
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Phone
ntractor
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Address
City/State Zip
Phone
Contractor City of FL Collins Sales Tax
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Are you paying taxes here or by report?
Are
Q Here Report
you paying with your trust account7)Yes
❑ No
Is this a residential or commercial projed? residential ❑Commercial
If residential, is it: )ASingle 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 morel ❑Yes 17 No Ifyes, you may need to ronbctH/slvdcPmserYvtYon
If this is for a demolition permit, what year was the building consbucted?
Ifpn'or to 197fe you will gged an asbestos assessmentto subarle iytltf7 thlsapplzwbran.
Description of work
*If lawn sprinkier/baddlow preventer, must list licensed plumber. If firstrtime A/C, must list licensed electridan.
Subcontractors: Llstthe company name orOty ofArColl/ns11cense 0
Electrician Plumber Merhanleel 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: i n'Slgnature
i�Date /o~r