HomeMy WebLinkAbout6932 Autumn Ridge Dr - Applications/Furnace - 08/14/2019City Of 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).
M Air Conditioning ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log A Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove
(must be EPA certified, provide make, model and manufacturer).
Complete all applicable information on th pplication. Incomplete applications will not be accepted.
Application # " � 01 Date
For office use only
Job Site Address (required)
Value of Construction (la aterials profit)
WIN 4ilwffln UP MIA
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Property Owner Name Address
City/State Zip
Phone
I I
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Applicant Name Address
J City/State Zip
Phone
Contractor Address
City/State Zip
Phone
SQ
LIVI 80138
030- ail -S il o
Contractor City o Ft. Collins Sales Tax #
Are you paying taxes here or by report?
K Here El Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
Yes ❑ No
Is this a residential or commercial project? 1% Residential ❑ Commercial
If residential, is it: P( Single 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 ,pl No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
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 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: „n v� , n„aAL bI��1I
Print Name: l U 10410 : nnmanl t� Signatul �Y(�/U Date q