HomeMy WebLinkAbout925 Bungalow Ct - Applications/Furnace - 11/13/2015City of
F6M CoWns
Manning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 # , (5D Date
For oruce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State
Zip
Phone
) r
1 c
PA.
Applicant Name Address_
City/State
Zip
Phone
Contractor Address
City/State
Zip
Phone
y
Contractor City of Ft. Collins Sales Tax#
7
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑"No
11
Is this a residential or co)"nmercial project? D"Residential El Commercial
If residential, is it: �7_Single Family Detached ElCondo/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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work ��� � i��.r`f ��� r - (� +/ ,.CE--P 1� L(%' a
'•`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: ,r1.1J I {/� �,/�i>'�:�( Signature(___.-
' ' ;'� Date f�l 2 a
Print Name. i 9 _ 1